Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Office of Medicaid 
600 Washington Street
Boston, MA 02111 
www.mass.gov/masshealth 

MASSHEALTH 
TRANSMITTAL LETTER ALL-144 
December 2006 

TO: All Providers Participating in MassHealth 

FROM: Beth Waldman, Medicaid Director 

RE: All Provider Manuals (Revised Appendix Y) 

Appendix Y has been updated to include additional REVS messages that do not have 
REVS restrictive message codes associated with them. These messages, however, 
are still important to understand before providing services. These new messages 
are listed on Page Y-5 under “Other Messages.” 

Effective December 8, 2006, several new messages will begin to appear on REVS. 
The first message is related to enrollment in a Commonwealth Care managed care 
organization (MCO). When a member is eligible for Commonwealth Care coverage, 
but has yet to select a Commonwealth Care MCO, the following message appears in 
REVS: 

620 MEMBER ALSO ELIGIBLE FOR COMMONWEALTH CARE. MEMBER MUST 
ENROLL IN MANAGED CARE TO RECEIVE THESE BENEFITS. CALL 1-877-MAENROLL. 

When a member is eligible for Commonwealth Care and has selected or been 
assigned to a Commonwealth Care MCO, but the coverage is not yet effective, the 
following message will appear in REVS: 

621 MEMBER ALSO ELIGIBLE FOR COMMONWEALTH CARE. ENROLLED WITH 
<Commonwealth Care MCO> PLAN. COVERAGE TO BEGIN <Mon 06>. 

In this message, <Commonwealth Care MCO> is the name of the Commonwealth Care 
MCO selected by or assigned to the member and <Mon 06> represents the effective 
date of Commonwealth Care coverage (three letters for the month and two digits 
for the year – for example, Dec 06). All Commonwealth Care enrollments begin on 
the first day of a calendar month. This change is effective for all access 
methods, except for the Automated Voice Response (AVR) system, which will be 
updated at a later date. 

Please note that a member’s eligibility may change or the member can change 
their Commonwealth Care MCO prior to the effective date of coverage. As always, 
check REVS before providing services. 




MASSHEALTH 
TRANSMITTAL LETTER ALL-144 
December 2006 
Page 2 

Another new message will appear when a MassHealth member has had more than one 
member identification number (ID) in REVS. In certain situations a member’s 
previous member ID may no longer be valid when submitting a claim to MassHealth. 
To help ensure that you submit the proper member ID for a member, REVS will 
return: 

“Member is Eligible - Use this RID for this Date of Service Only” 

This message indicates that the member you are providing services for has more 
than one member ID on REVS. As a result, the member ID you requested is not the 
member ID you should submit on the claim for that date of service. However, the 
member ID you queried is still considered active and should be used in future 
inquiries on REVS. 

If you have any questions about the information in this transmittal letter 
please contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. 

NEW MATERIAL 
(The pages listed here contain new or revised language.) 

All Provider Manuals 

Pages Y-1 through Y-6 

OBSOLETE MATERIAL 
(The pages listed here are no longer in effect.) 

All Provider Manuals 

Pages Y-1 through Y-6 — transmitted by Transmittal Letter ALL-142 




Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-1 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

REVS Codes and Messages 

Important Note: This appendix is available online at 
www.mass.gov/masshealthpubs. MassHealth will 
update Appendix Y as needed. Paper copies of this appendix will not be mailed 
automatically, but can be requested by mailing, faxing, or e-mailing a request 
to: 

MassHealth Publications 

P.O. Box 9118 
Hingham, MA 02043 
Fax: 617-988-8973 
E-mail: publications@mahealth.net 
This appendix lists the active Recipient Eligibility Verification System (REVS) 
codes and their respective service-restriction messages. Providers accessing 
REVS to verify a patient's eligibility before providing medical services will 
receive one or more of the following restriction messages. 

This appendix also lists other messages that do not have a code associated with 
them, but are important to be aware of, as they are returned on REVS. 

Code Message 

006 NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-462-5449. FOR 
BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820. 

011 NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-462-5449. FOR 
BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820. 

021 BMC HEALTHNET MEMBER. FOR MEDICAL SERVICES CALL 1-888-566-0010. 
FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501. 

031 PRIOR AUTH REQUIRED ON ALL CARE EXCEPT EMERGENCIES. ESP NORTH 

SHORE. CALL 781-581-3900 FOR LYNN CLIENTS, 978-837-9479 FOR BEVERLY 

CLIENTS. 

035 DMH CLIENT. 

036 PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR 
EMERGENCIES. CALL ESP OF THE CAMBRIDGE HOSPITAL AT 617-868-6323. 

041 PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR 
EMERGENCIES. CALL ESP AT FALLON AT 508-852-2026. 

046 PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR 
EMERGENCIES. CALL ESP OF UPHAM’S CORNER AT 617-288-0970. 

051 PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR 
EMERGENCIES. CALL HARBOR ELDER SERVICES AT 617-296-5100. 

056 NETWORK HEALTH MEMBER. FOR MEDICAL SERVICES CALL 1-888-257-1985. 
FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-257-1986. 

061 BMC HEALTHNET PLAN MEMBER. FOR MEDICAL SERVICES CALL 
1-888-566-0010. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501. 




Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-2 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

Code Message 

066 NETWORK HEALTH MEMBER. FOR MEDICAL SERVICES CALL 1-888-257-1985. 
FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-257-1986. 

071 MEMBER ENROLLED IN PROGRAM THAT LIMITS HIM/HER TO 1 PHARMACY. 
FOR INFORMATION, MEMBER MAY CALL 1-800-841-2900, 8AM-5PM MON-FRI. 

075 MEMBER ID MAY HAVE BEEN USED IN THE PAST BY MORE THAN ONE 
MASSHEALTH MEMBER. VERIFY MEMBER NAME AND BIRTHDATE ON RESPONSE. 

096 CARE MANAGEMENT PILOT PROGRAM MEMBER. PLEASE CALL 413-794-9428 
TO COORDINATE ALL MEDICAL AND BEHAVIORAL HEALTH SERVICES. 

111 RESIDENT AT LONG-TERM-CARE FACILITY. 

116 EAEDC (CAT. 04). SERVICES RESTRICTED. SEE 130 CMR 450.106. FOR 
QUESTIONS, CALL PROVIDER SERVICES AT 1-800-841-2900. 

121 DIRECT ALL INQUIRIES ABOUT ELIGIBILITY TO SOCIAL SERVICE WORKER. 

126 COMMUNITY CASE MANAGEMENT MEMBER. PRIOR AUTHORIZATION NOW 
REQUIRED FOR HOME HEALTH (PDN, NURSING, HH AIDE, PCW) INFO 
1-800-863-6068. 

131 FALLON MEMBER. FOR MEDICAL SERVICES CALL 1-800-868-5200. FOR 
BEHAVIORAL HEALTH SERVICES CALL 1-888-421-8861. 

171 PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR 
EMERGENCIES. CALL ESP OF EAST BOSTON AT 617-568-6416. 

186 EXEMPT FROM COPAY ON NON-PHARMACY SERVICES UNDER 130 CMR 450.130(D). 

201 SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION 
NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL CCA: 
1-866-610-2273. 

231 SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION 
NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL SWH: 
1-888-794-7268. 

246 EXEMPT FROM COPAY ON PHARMACY SERVICES UNDER 130 CMR 450.130(D). 

271 MET CAP ON NON-PHARMACY SERVICES UNDER 130 CMR 450.130(C). 

281 UNCOMPENSATED CARE POOL IS FOR CERTAIN HOSPITAL AND CHC SERVICES 

ONLY. FOR MORE INFORMATION, CALL 1-877-910-2100. 

306 INDIVIDUAL HAS SUBMITTED AN MBR AND IS NOT ELIGIBLE FOR 
MASSHEALTH. FOR MORE INFORMATION, CALL 1-800-462-7738. 

311 FALLON MEMBER. FOR MEDICAL SERVICES CALL 1-800-868-5200. FOR 

BEHAVIORAL HEALTH SERVICES CALL 1-888-421-8861. 

366 MET CAP ON PHARMACY SERVICES UNDER 130 CMR 450.130(C). 

386 MEDICARE-COVERED SERVICES ONLY. 




Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-3 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

Code Message 

391 SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION 
NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL EVERCARE: 
1-888-867-5511. 

461 PRIMARY CARE CLINICIAN (PCC) PLAN MEMBER. CALL PCC FOR 
AUTHORIZATION FOR ALL SERVICES EXCEPT THOSE LISTED IN 130 CMR 
450.118(J). 

480 BILL MEMBER’S PRIVATE HEALTH INSURANCE. SEE 130 CMR 450.316-317 FOR 
INFO ON TPL REQS AND PAYMENT LIMITATIONS ON CLAIM SUBMISSIONS. 

485 BILL MEMBER’S PRIVATE HEALTH INSURANCE. MASSHEALTH PAYS ONLY 
FOR COPAYS AND DEDUCTIBLES FOR WELL-CHILD VISITS. 

490 DMH CLIENT. NOT ELIGIBLE FOR MASSHEALTH. 

495 ELIGIBLE FOR PREMIUM ASSISTANCE ONLY. BILL MEMBER'S PRIVATE 
HEALTH INSURANCE. 

500 SPECIAL NHP PROGRAM. CALL NHP FOR AUTHORIZATION FOR ALL SERVICES 
EXCEPT FAMILY PLANNING, GLASSES, AND MOST DENTAL. 1-888-816-6000 

505 MASSHEALTH COMMONHEALTH MEMBER. FOR QUESTIONS, CALL 
1-800-841-2900. 

516 CALL HRCA AT 617-325-8000 FOR AUTHORIZATION OF ALL SERVICES EXCEPT 
ACUTE INPATIENT ADMISSIONS. 

520 ELIGIBLE FOR AMBULATORY PRENATAL CARE ONLY. 

522 ELIGIBLE FOR EMERGENCY SERVICES ONLY. 

525 FOR MENTAL HEALTH OR SUBSTANCE ABUSE SERVICE AUTHORIZATION, 
CALL THE PARTNERSHIP AT 1-800-495-0086. 

530 NO PCC/MCO AUTHORIZATIONS NEEDED. FOR MH/SA SERVICE AUTHORIZATION, 
CALL THE PARTNERSHIP AT 1-800-495-0086. 

595 MEMBER ELIGIBLE BUT NOT ENROLLED IN MANAGED CARE. SERVICE 
CANNOT BE BILLED TO MASSHEALTH. MEMBER MUST CALL CUSTOMER 
SERVICE 1-800-841-2900. 

596 MEMBER ALSO ELIGIBLE FOR ESSENTIAL. MEMBER MUST ENROLL IN 
MANAGED CARE TO RECEIVE THESE BENEFITS. MEMBER MUST CALL 
800-841-2900. 

597 MEMBER ALSO ELIGIBLE FOR BASIC. MEMBER MUST ENROLL IN MANAGED 
CARE TO RECEIVE THESE BENEFITS. MEMBER MUST CALL 800-841-2900. 

601 ELIGIBLE FOR EMERGENCY SERVICES, INCLUDING LABOR AND DELIVERY, 
UNDER LIMITED WITHOUT COPAY UNDER 130 CMR 450.130(D). 

602 FOR ELIGIBILITY DATES AND PAYMENT FOR ALL OTHER PREGNANCYRELATED SERVICES 
UNDER HEALTHY START, CALL 1-888-488-9161. 




Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-4 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

Code Message 

603 ELIGIBLE FOR EMERGENCY SERVICES UNDER LIMITED WITHOUT COPAY 
UNDER 130 CMR 450.130(D). 
604 FOR ELIGIBILITY DATES AND PAYMENT FOR PRIMARY AND PREVENTIVE 
CARE SERVICES CALL CMSP AT 1-800-909-2677. 
605 FOR ELIGIBILITY DATES AND PAYMENT FOR PRIMARY AND PREVENTIVE 
CARE SERVICES CALL CMSP AT 1-800-909-2677. 

606 REIMBURSEMENT FROM THE UNCOMPENSATED CARE POOL NOT 
ALLOWABLE FOR THIS PATIENT. FOR INFORMATION CALL 617-988-3222 OR 
1-877-910-2100. 

608 MEMBER ELIGIBLE FOR MEDICARE PART D. FOR MEMBER ENROLLMENT 
STATUS OR OTHER INFORMATION CALL 1-800-MEDICARE (1-800-633-4227). 
609 YES. MEMBER HAS FULL MEDICAID BENEFITS. 
610 NO. MEMBER DOES NOT HAVE FULL MEDICAID BENEFITS. 
611 MEMBER IS QUALIFIED MEDICARE BENEFICIARY. SEE 130 CMR 519.010. 
612 MEMBER IS SPECIFIED LOW INCOME MEDICARE BENEFICIARY. SEE 130 CMR 
519.011(A). 
613 MEMBER IS QUALIFIED INDIVIDUAL BENEFICIARY. SEE 130 CMR 519.011(B). 
614 BILL HOSPICE PROVIDER IF SERVICE IS RELATED TO TERMINAL ILLNESS. 
615 BMC HEALTHNET PLAN MEMBER. FOR MEDICAL SERVICES CALL 
1-888-566-0008. FOR BEHAVIORAL HEALTH SERVICES CALL 1-866-444-5155. 
616 NETWORK HEALTH MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478. 
617 NHP MEMBER. FOR DENTAL SERVICES CALL 1-800-685-9971. FOR VISION 
SERVICES CALL 1-800-462-5449. 

618 BMC HEALTHNET PLAN MEMBER. FOR DENTAL SERVICES CALL 
1-800-685-9971. FOR VISION SERVICES CALL 1-800-615-1883. 

619 FALLON COMMUNITY HEALTH PLAN MEMBER. FOR DENTAL SERVICES CALL 
1-800-868-5200. FOR VISION SERVICES CALL 1-800-868-5200. 

620 MEMBER ALSO ELIGIBLE FOR COMMONWEALTH CARE. MEMBER MUST 
ENROLL IN MANAGED CARE TO RECEIVE THESE BENEFITS. CALL 
1-877-MA-ENROLL. 

621 MEMBER ALSO ELIGIBLE FOR COMMONWEALTH CARE. ENROLLED WITH 
<Commonwealth Care MCO> PLAN. COVERAGE TO BEGIN <Mon 06>. 




Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-5 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

Other Messages 

This section lists messages returned from REVS that do not have a code 
associated with them. While they do not have an associated code, these messages 
are still important when providing services. 

Member is Eligible Member is eligible based on the services and restrictions 
indicated for the date of service inquired upon. 
Member is Eligible – RID has 
changed Member is eligible based on the services and restrictions 
indicated for the date of service inquired upon. The member ID 
inquired upon for this member has changed. The new member 
ID is displayed and should be used for billing purposes. 
Member is Not Eligible Member is not eligible on date of service inquired upon. 
Member was eligible for benefits at some time in the 13 months 
prior to the date of inquiry. 
Member Not Found Member is not known to REVS. 
Member is Eligible - Use this 
RID for this Date of Service Only 
Member is eligible based on the services and restrictions for the date of 
service inquired upon. However, the member ID that you need to submit on the 
claim for payment differs from the 
member ID that you entered in REVS. Submit the claim with the member ID returned 
but use the member ID you entered in REVS for future eligibility inquiries. 
PCC Member. Call (corporate & site name, if applicable) (phone 
number) for approval. For exceptions see 130 CMR 
450.11.8(J) 
Member is enrolled with a Primary Care Clinician (PCC.) The corporate PCC and 
site PCC (if applicable) names will be displayed. The site PCC phone number will 
be displayed. 
Duplicate RID. Call 1-800-8337582 for assistance. 
The member ID entered has been linked to more than one member on REVS. Call the 
Eligibility Operator to determine the appropriate member ID to check 
eligibility. 


Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Appendix Y. REVS Codes/Messages 
Page 
Y-6 
All Provider Manuals 
Transmittal Letter 
ALL-144 
Date 
12/01/06 

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