Massachusetts Medicaid: Prior authorization, HCPCS coding and member ID updates
AI Summary
Massachusetts Medicaid updated prior authorization requirements for home health services in SCO and One Care plans, clarified that Medicare-certified home health services no longer require prior auth, and updated HCPCS G-code requirements for billing. Some members also received new subscriber ID numbers that must be verified to prevent claim rejections.
Action Required
Immediately: Billing team must verify member subscriber IDs using Provider Portal Eligibility & Benefits search before submitting claims to prevent rejections. Update home health billing to use specified G-codes and revenue codes per the contracted payment appendix. Stop requiring prior authorization for Medicare-certified home health services but continue prior auth for ASAP services using G0156 and G0299 codes.
Affected Billing Codes
Plan Types
Medicaid
States
MA
Specialties
all-specialties