MassHealth has completed the rate updates for the July 1, 2025 Quarterly Drug Codes. The impacted claims will be reprocessed and/or adjusted and will appear on a future remittance advice.… Continue Reading Update For Quarterly Drug Code Rates Effective July 1, 2025
To allow for system maintenance, the MMIS POSC, Provider Portal, HTS transactions, internal MMIS application, EVS and all eligibility services will be unavailable on Sunday, September 14, 2025, from 4:00… Continue Reading MMIS System Outage Notice – Sunday, September 14, 2025
Effective October 1, 2025, provider file update requests for non-LTSS and non-dental MassHealth providers will no longer be accepted via fax. To ensure timely processing of your updates moving forward,… Continue Reading REVISED – Provider File Update Requests by Fax Submissions to Be Discontinued Effective October 1, 2025
Effective August 1, 2025, MassHealth has added home health services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan… Continue Reading Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for Home Health Services
Effective August 1, 2025, MassHealth has added independent nursing services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan… Continue Reading Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for Independent Nursing Services
Effective August 1, 2025, MassHealth has added Continuous Skilled Nursing (CSN) agency services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care… Continue Reading Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for CSN Agency Services
Effective August 1, 2025, MassHealth has added therapist services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or… Continue Reading Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for Therapist Services
Effective August 1, 2025, MassHealth has added prosthetic and orthotic services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC)… Continue Reading Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for Prosthetic and Orthotic Services
This is a reminder that Prior Authorization (PA) is required if a member has received a hearing aid within the last five (5) years. Please remember that a PA is… Continue Reading Hearing Aid Claim Denials & Prior Authorization
Health Connector Federal Policy Updates The federal government recently passed a budget reconciliation bill on July 4, 2025. As a result, many Health Connector members will see increases in the… Continue Reading Health Connector Federal Policy Updates: ConnectorCare Program Changes
