Mass Health Changes in Mid-Level Provider Enrollment

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physician credentialing

Changes to Mass Health Enrollment for Mid-Level Practitioners; Physical & Occupational Therapists; Independent Nurses.

MassHealth, the state Medicaid program for Massachusetts, is moving forward with Mid-Level Practitioner amendments proposed in April of this year. It is anticipated that the updated amendments will go into effect on or after 8/1/2017; MassHealth is directing practices to begin enrolling the providers affected by these updates in order to remain in compliance. The proposed changes include enrollment for:

  • Physician Assistants working in a group practice with at least one (1) physician, the group practice is to bill for the PA’s services
  • Certified Registered Nurse Aneshetists (CRNAs), Psychiatric Clinical Nurse Specialists (PNCSs), and Clinical Nurse Specialists (CNSs)
  • Nurse Practitioners and Certified Nurse Midwives will continue to participate in MassHealth
  • NPs, NMWs, CRNAs, PCNSs, and CNSs can bill for their own services, or a group practice can bill for their services (See Additional information below about utilizing LTSS for enrolling Independent Nurses)

Providers are encouraged to submit the updated version of the Practitioner Application and supporting documents to start the enrollment process. MassHealth has scheduled webinars to review these regulations and billing changes.

Effective 05/31/2017 MassHealth has entered an agreement with Optum to provide third-party-administration (TPA) for Long-Term Services and Supports (LTSS). The bulletin can be reviewed here. The LTSS-TPA will be responsible for claims submission and resolution; prior authorization, provider enrollment, revalidation and updates for the following provider types:

  • Adult day health • Adult foster care • Chronic inpatient hospitals • Chronic outpatient hospitals • Day habilitation • Durable medical equipment • Group adult foster care • Home health agency services • Hospice • Independent nurse (private duty nursing) • Independent therapist (including Physical, Occupational, and Speech) • Nursing facilities • Orthotics • Oxygen and respiratory therapy • Personal care attendant • Transitional living • Prosthetics • Rehabilitation centers • Speech and hearing centers