MassHealth SSU Escalation Overview and Access Guide
Learn about MassHealth SSU (Service Solutions Unit) and how to escalate cases for urgent assistance. Discover what cases can be escalated, how to access the SSU, and types of issues eligible for escalation within the MassHealth program.
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Presentation Transcript
Overview of MassHealth SSU Escalation Executive Office of Health and Human Services February 2024
Overview: MassHealth Escalation Service Solutions Unit What is the MassHealth SSU? What cases CAN be escalated to the SSU? In 2023, MassHealth piloted the Service Solutions Unit (SSU) to assist external partners with escalated cases Cases that were unable to be resolved after contacting the MassHealth Enrollment Center or Customer Service Urgent or emergency cases that need immediate assistance Cases to review/correct eligibility determinations Cases can only be referred to the SSU if there is no resolution available through MassHealth Customer Service or MassHealth Enrollment Center How does the SSU support escalations? What cases SHOULD NOT be escalated to the SSU? The unit is responsible for performing in- depth research on high priority cases by correcting and providing the root cause in a timely manner Request to verify eligibility Request to receive a MassHealth card General eligibility inquiries or questions that can be addressed by MassHealth Customer Service or MassHealth Enrollment Center SSU provides 1 to 2 business day turn around on all case inquiries from advocates & partner agencies
How can you access the SSU for escalated cases? 1. Fill out the SSU escalated request template (see following slide) and paste it into the body of an email 2. Email subject line and group should be: SSU Eligibility 3. Select a Priority Level: Level 1: Urgent medical appointment, Level 2: Risk of coverage loss Level 3: Escalated eligibility case for review 4. Send the email to EHS-DL-ITRequests@MassMail.State.MA.US Note: No additional action is required after sending an email to SSU. SSU staff will research the case and respond to your email within 1 to 2 days Sample e-mail template available on next page
SSU E-mail Template Email Subject Line SSU - Eligibility Field Description Sender Name: Sender Office: Priority Level: Group: SSU - Eligibility Member Medicaid ID# Request Content:
Types of Issues to Escalate for SSU Eligibility Program Long Term Cases Member Escalations SSA inquiry Immigration Urgent medical need Premium Verification Letters Disability Premium Medicare buy-in Starting coverage End coverage PARIS match Notice of birth Member support Eligibility Policy Health Plan Enrollment Provider Legal HIX or MA21 Issues MMIS Issues LTSS Behavioral Health Pharmacy Dental Member Engagement BOH HSN Verification Indexing error Other
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