Healthcare providers dealing with MassHealth
patients turn to PV Kent & Associates to circumvent the traps
and pitfalls of processing claims with the Office of Medicaid. We understand
the unique intricacies of dealing with MassHealth. In addition,
we have established excellent working relationships with the Office
of Medicaid that often allow us to expedite payment.
applies its Best Practices for Reimbursement to managing claims
submissions to MassHealth. Our procedures maximize the accuracy
and completeness of every claim and ensure adherence to every step
of the claims process.
Kent's MassHealth Claims Services
Because we are intimately familiar with MassHealth
regulations and procedures, we are ideally prepared to:
Handle issues specific to inpatient and outpatient services
Investigate and resolve issues that arise out of Medicaid
Verification System restrictions
Pursue payment and coordinate split payments between MassHealth
managed care organizations, including Neighborhood Health
Health, BMC HealthNet, and Fallon Community Health
Resolve issues surrounding dual diagnosis claims (e.g., medical
Pursue retroactive and prior authorizations
Retrieve and provide medical records to the Office of Medicaid, as necessary
Ensure consistency and accuracy of universal billing and
Ensure consistency and accuracy of diagnosis and procedure
Resolve issues with primary care physician/clinician referrals
File appeals with the FDAB (Final Deadline Appeal Board)
Challenge medical necessity claim denials
Request fair hearings
Perform legal reviews and file CJRs (Complaints for Judicial
authorized by our clients
When it comes to MassHealth claims, the bottom
line is, "A Clean Claim Gets Paid." Our
claims processing team scrutinizes submissions for likely errors,
inconsistencies, and missing data.
work with our clients various departments to ensure the accuracy
of authorizations, referrals, coding, medical records, hospital
clinical notes, proof of facsimile submissions, and much more. In
the event that a claim involves motor vehicle insurance, workers
compensation, the Veterans Administration, or other insurers, we
coordinate benefits and the hierarchy of payment, as necessary.
submit most claims electronically; we can also send facsimile or
hardcopy claims, as the circumstances warrant.
Tracking and Reporting
Kents fully automated collection/tracking/scheduling
system allows our specialists to expedite the reimbursement process.
It also permits our clients to ascertain the status of every claim
in real time.
automated system generates customized reports that offer extraordinary
insight into general trends, granular details, and provides tactical and
statistical information for use in improving processes and procedures. Since information requirements vary greatly
among healthcare providers, we tailor our reports to each client's specific needs.
fact, Kent managers review the same reports for quality control
purposes. They look for repeated problems, recommend remedies, and
provide in-service training, showing clients how to avoid these
problems by changing the way they work. We provide these services
at no extra cost as part of our ongoing partnership with our clients.
Denials and Appeals Management
Healthcare providers miss out on hundreds
and thousands of dollars of potential revenue each year due to incorrect
denials from MassHealth. These losses often occur because of inadequate
staffing, delays, and mistakes that are simply beyond the healthcare providers' control.
prevents and appeals denials with a level of attention that would
be impractical for most healthcare providers. Even before a claim
is submitted, our MassHealth specialists discover and rectify potential
problems caused by incomplete or inaccurate forms, billing deadline
discrepancies, coding errors, and lack of referrals.
the event that MassHealth denies payment, we notify our client of
the result and the reason. If the denial is unjustified, our appeals
specialists resubmit the claim with the corrected and amended information.
In the instances where standard appeals procedures
are unsuccessful and/or the Office of Medicaid denies a claim for improper
administrative reasons, Kents legal team offers advocacy and
negotiation services, as well as litigation support. Our attorneys
have the qualifications to appeal claims to the highest level, request
fair hearings, and file complaints for judicial review with the
appropriate court, when necessary and appropriate. These capabilities make us unique in the industry and often eliminates the need for multiple outsourcing efforts.