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The Top 10 MassHealth Applications Questions

You need to know the answers to these questions to truly understand whether your MassHealth applications staff is maximizing available reimbursement opportunities.

If your MassHealth applications staff cannot answer yes to all 10 of the following questions, it is very likely that your facility is not maximizing MassHealth revenue opportunities and is therefore leaving medicaid reimbursement dollars on the table.

Top 10 MassHealth Applications Questions

1.) Our applications staff knows at the time of application exactly what category of eligibility under MassHealth, the Commonwealth Connector program and/or the Uncompensated Care Pool that each applicant should ultimately qualify for. Yes or No?

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2.) Our applications staff knows at the time of application what the correct start date should be for all MassHealth applications filed and what to do if the start date is incorrect. Yes or No?

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3.) Our applications staff is sufficiently equipped to perform all necessary follow-up, in a timely fashion, to properly complete the MassHealth documentation requirements to ensure that the application is processed to a favorable determination. Yes or No?

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4.) Our applications staff consistently tracks MassHealth eligibility verification deadlines and is able to act prior to the expiration of such deadlines to ensure that the potential retroactive eligibility start date is not compromised. Yes or No?

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5.) Our applications staff ensures that the appropriate documentation is completed for all applications to ensure that our healthcare facility is not only authorized to track and receive notice of actions taken by MassHealth on the applications we submit on behalf of our patients, but also to allow us to take affirmative action to correct erroneous denials or approvals, when necessary. Yes or No?

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6.) Our applications staff files the appropriate appeals when erroneous denials or incorrect approvals are received on the applications we file on behalf of our patients. Yes or no?

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7.) Our applications staff knows what a "post-eligibility date" is and why ensuring that this date is correct is critical to the likelihood and timeliness of our facility receiving payment from MassHealth for the services provided. Yes or No?

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8.) Our applications staff aggressively pursues the correct retroactive eligibility start date in MassHealth long-term care and community disability cases. Yes or No?

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9.) When a disability application is filed, our applications staff secures all available medical records, issues consultative exam reminders and prosecutes appeals to ensure the highest rate of approval possible. Yes or No?

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10.) Our applications staff knows all applicable MassHealth regulations, including the Fair Hearing procedural rules, so as to ensure that all avenues of securing the highest level of benefits from the earliest possible start date are aggressively pursued. Yes or No?

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