FAQs: For Providers

We have identified two main root causes that have created issues in processing claims:

1. Provider mapping: MassHealth uses a unique identifier for providers (PID/SL) that can tie to multiple NPIs or Tax IDs. This mapping is complex and needs specific logic in the claims processing system so that claims are affiliated with the right provider and location. Claims processing has been slower than normal as we have worked to ensure this logic and mapping is correct and that payments are being made to the correct provider.
2. Multiple lines on a claim: There was an issue with the way that claims were being processed by BeneCare that resulted in only the first line on a claim being read. Claims were coming in but only the first service line was being processed. This resulted in much lower than expected payments on many claims.

As of June 3rd, around $34M of payable claims have been processed so far since the dental third party administrator (TPA) transition, which is about half of normal historic payment volume. MassHealth will have issued approximately $72M in post-transition payments to providers, including interim advances and less any recoupments.

Starting with the 6/2 claims payments and going forward, weekly claims payments are much closer to normal for more providers due to the major claims fixes (provider mapping and multiple line on claims.

Previously processed claims and claims that previously could not be processed due to providing mapping issues will be remediated, processed, and paid over the month of June. Providers do not need to resubmit claims at this time.

For providers who continue to receive much lower-than-expected claims payments, we continue to work through some provider-specific issues and are reaching out to those providers directly.

If you haven’t already received outreach from the BeneCare team and you either haven’t any claims payment or your payment remains very low, please fill out this form so that we can assist you.

MassHealth will also continue to make interim payment advances to providers who need them upon request over the coming weeks.

BeneCare will be reprocessing claims where only the first line was paid. We anticipate that over the month of June all impacted claims will be remediated and reprocessed for payment. Providers do not need to resubmit claims at this time.

Yes, claims can be sent through the MassHealth Dental electronic payor ID: CKMA1 or (for providers with approved electronic waivers on file with MassHealth) mailed to:

MassHealth Dental Program Claims
c/o BeneCare Dental Plans
P.O. Box 631
Worcester, MA 01613

For details, refer to Section 4.00 “Claim Submission Procedures (Claim Filing Options)” of the Office Reference Manual.

Please attach the primary EOB when submitting the claim.

Claims and prior authorization and pre-determination requests have been processing slower than expected due to the claims issues detailed above. As these issues are resolved, this information will be available in the portal.

If the claim or request was submitted online and a reference number was provided after submission, the claim or request has been received. The reference number can be found when selecting the option to print a copy of the claim or request that appears on the confirmation screen after submission. The print option will generate an American Dental Association (ADA) claim form version of the request with a reference number at the top.

We are currently working to fix this error. If a “Procedure Date” is included, it will be processed as a claim. If no “Procedure Date” is included, it will be processed as a prior authorization or pre-determination request.

Enter the facility name and address in the Remarks section of the claim.

Telehealth claims should be submitted using the place of service (POS) codes 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home). If submitting the claim through the provider portal, enter the  telehealth place of service under Remarks.

MassHealth does not currently use the teledentistry CDT codes D9995 and D9996. Please refer to MassHealth All Provider Bulletin 379 for more details on the MassHealth telehealth policy. The same rules and requirements, including documentation and recordkeeping standards, for covered services that are delivered in-person apply to services delivered by telehealth.

Enter the service location address in the Remarks section of the claim to demonstrate that covered services were provided in one of the five eligible rural counties: Barnstable, Dukes, Berkshire, Franklin, and Hampshire.

Claims missing documentation will be pend and providers will receive written notification about the specific documentation that is needed to process the claim. Letters will be issued in bi-weekly batch transmittals that summarize any claims that are pended for missing documentation and specifies what information is needed.

Providers who batch submit claims through a clearinghouse without electronic
attachments will have any specific claims pend which require additional documentation. Providers then will receive bi-weekly letters listing each of the pended claims and the missing documentation details.

On the provider portal, providers can look up an existing pended claim from the information on the letter and append additional documentation to that claim via the upload function. There is no cost to the provider for this function.

This means that providers can keep their existing electronic clearinghouse claims submission process and add this additional step to submit missing documentation through the provider web portal.

Please note that this additional documentation provider portal function does not allow for editing of a claim in-process. Void, edit, or other change requests will need to be transmitted separately.