Providers to Receive Letters for TPL Claims Beginning September 8, 2009

Providers should expect to see letters from “Commonwealth Medicine” representing the MassHealth TPL (Third Party Liability)  Unit on or about September 8, 2009. The letter, which will take the form of an “Initial Overpayment Notice,” will list those claims for dually-eligible beneficiaries that MassHealth has identified as requiring a Medicare determination of coverage. MassHealth is the payer of last resort and as the subrogee for these beneficiaries is requesting that you begin the demand bill process to determine if Medicare should have been billed for these services.    The claims in dispute are for Federal Fiscal Year 2008 or dates of service October 1, 2007 through September 30, 2008.

In preparation for this initiative, the Alliance in cooperation with MassHealth held 2 workshops for providers in July and August.  The process and expectations were discusses by representatives of the TPL Unit and the Provider Outreach and Education department of National Government Services reviewed the “demand bill” process.

For a copy of the TPL Powerpoint which includes an excellent timeline,  click here. For a copy of the NGS presentation discussing the demand billing process, click here

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