Provider Monthly:  MassHealth discharge planning, Medicare balance, and recognizing National Diabetes Awareness Month during November 2021

Featured Story:

Learn about the program designed to prevent or delay the development of diabetes

AllWays Health Partners and The Massachusetts General Hospital Diabetes Center offer the Path to Lifestyle Change program to help our members lose weight—and delay or prevent type 2 diabetes. The Path to Lifestyle Change was created and is being directed by Linda Delahanty, MS, RD, the Director of Nutrition and Behavioral Research at the Mass General Diabetes Center. In recognition of National Diabetes Awareness Month, continue reading to learn more about Linda’s passionate commitment to supporting anyone impacted by diabetes.


Keep reading

To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

  • MassHealth discharge planning to support members experiencing or at risk of homelessness
  • Medicare balance
  • Return to pre-pandemic rates for telehealth services
  • 2022 product trainings
  • Reminder if your practice provides PANS/PANDAS services
  • Provider service line wait times 
  • Medical policies
  • Code updates
  • Drug updates

MassHealth discharge planning to support members experiencing or at risk of homelessness

MassHealth worked in coordination with the Department of Housing and Community Development, the Interagency Council on Housing and Homelessness, and other departments within the Executive Office of Health and Human Services to better align expectations for Acute Inpatient Hospitals, Freestanding Psychiatric Hospitals, and emergency shelters in order to decrease the number of people who are discharged from healthcare facilities directly to homeless shelters. To assist discharging hospitals and shelters MassHealth has developed new tools and guidance, all of which are available on a new website: Helping Patients who are Homeless or Housing Unstable. 

MassHealth also published “Discharge Planning to Support Members Experiencing or at Risk of Homelessness” bulletins for Acute Inpatient Hospitals, Freestanding Psychiatric Hospitals, and Managed Care Entities. The bulletins describe discharge planning procedures designed to enable hospitals to identify MassHealth members experiencing or at risk of homelessness in a timely fashion after admission and to ensure that such members have access to the post-hospital care, including an appropriate place to live, or other services that they need.

Medicare Balance

  • AllWays Health Partners Medicare Balance plan provides secondary coverage to Medicare—all members are required to have both Medicare Parts A and B.
  • Medicare Balance does not have a provider network, so members may choose to see any doctor, anywhere in the nation, who accepts Medicare! And don’t worry about providing referrals—members don’t need a referral to see a specialist.
  • For billing purposes, Medicare should be listed as the member’s primary coverage and AllWays Health Partners Medicare Balance as their secondary coverage.
  • AllWays Health Partners Medicare Balance pays any remaining deductible or coinsurance amount not covered by Medicare, less any applicable copays required by the plan design (this will vary by employer)
  • Below is a sample of the ID card members of Fallon Medicare Plus Freedom will present when accessing your services. (attached to email if you want to include)

On January 1, 2022, we will return to pre-pandemic rates for telehealth services.

We will return to pre-pandemic rates for telehealth services on 1/1/2022. For dates of service beginning January 1, 2022, we will return to reimbursing at pre-pandemic rates for services rendered via telemedicine, with the exceptions of primary care, chronic care, and behavioral health. You can learn more by reviewing our Telemedicine and COVID-19 payment policies. Please note that behavioral health services are managed by Optum, and you can find information about their policies on their Provider Express portal

As we revert back to pre-pandemic operations and policies, we make these changes in accordance with state law (Chapter 260) and related guidance. There will be no changes to the scope of services that are allowed via telemedicine, at this time. We will continue to communicate with you as more information becomes available.

2022 product trainings

We are currently preparing for 2022 product trainings. We will share more information as it becomes available, so please be sure to check your inbox and our provider education page for the latest.

Reminder if your practice provides PANS/PANDAS services

Following a recent state mandate, AllWays Health Partners is working to ensure our members have access to providers who can diagnose and treat Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
If your practice provides these services, please take a moment to fill out our brief survey. You'll be asked for information about your practice and area of expertise. With your permission, we'll also use your submission to refer patients to your practice.

Your response to this survey will help us ensure adequate network access to PANS/PANDAS services for our members. We appreciate your participation! 

Provider service line wait times 

Like many companies across the country, we are actively working to expand and grow our teams across customer service and other areas. With that in mind, you may experience longer wait times on our provider service line. The self-service tools on our provider portal are currently the fastest way to:

  • Confirm member benefits
  • Submit or check a prior authorization request
  • View your EOP and payment information

As always, thank you for your partnership and for the care you provide our members.

Medical policies

Two medical policies have been posted to with a 11/1/2021 effective date.  Please go HERE to see the updated policies.  

10/1/2021 Off-cycle Medical Policy Review

Code Updates

Drug Updates

Formulary updates

Updates for Commercial Members