Effective: 03-01-22
Supersedes:
Purpose
To establish a formalized process to handle all statutorily not covered service claims that Medicare will not pay, and beneficiary has MassHealth secondary.
Policy
Brewster Ambulance billing team will now file MassHealth primary for all services that are statutorily not covered by Medicare. The billing team will only file with MassHealth when the patient has a MassHealth policy that pays all or part of ambulance transports.
MassHealth policies that pay all or part of ambulance transports are:
Common Health
Care Plus
Standard
Procedure
Prior to March 1, 2022, Brewster billing office was filing all claims to Medicare to get a denial for claims statutorily not covered by Medicare (i.e., doctor and diagnostic transports).
MassHealth has updated their system and is now able to accept claims without the Medicare EOB for claims that are not covered.
Brewster Ambulance currently places a GY modifier for doctor visits and diagnostic centers. This will change on March 1, 2022. The billing team will file directly to MassHealth without the GY modifier.