Month: December 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, December 21st, 2025, from 4:00 PM to 10:00 PM. MAP, CBHI, MeNoB, member and eligibility web services and Netreveal predictive modeling application servers will also be impacted. We apologize for… Continue Reading MMIS System Outage Notice – Sunday, December 21, 2025

MassHealth identified that certain Community Behavioral Health Center (CBHC) claims for Medicare Savings Plan (MSP) members (formerly known as Senior Buy-in) were incorrectly denied for edit 2609 “SBI benefit plan – not a covered service”. Specifically, claims billed to MassHealth for the CBHC clinic per diem bundle that included a payment and/or patient responsibility from… Continue Reading Reprocessing Community Behavioral Health Center (CBHC) Claims Denied in Error

MassHealth identified an issue that caused incorrect pricing on certain group practice Medicare crossover claims, leading to overpayments. This occurred when the rendering provider was a mid-level practitioner and the place of service was 02 or 10 (telehealth). The issue has been resolved, and all impacted Medicare crossover claims adjudicated on or after February 1,… Continue Reading Adjusting Certain Group Practice Medicare Crossover Claims

Effective December 1, 2025, Provider Expiration Notices for Provider Requests for Transportation (PT-1s) will no longer be mailed. Please continue to monitor the Upcoming Expirations tab within the Customer Web Portal (CWP) for updates on existing PT-1 status: https://masshealth.ehs.state.ma.us/CWP/Default. If you have questions, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900. LTSS providers, please contact… Continue Reading Mailing Discontinued for PT-1 Provider Expiration Notices

MassHealth implemented edit 9974 “PM: deny-service not covered/payable by MassHealth” in May 2025 to deny crossover claims billed with modifier JW ‘drug amount discarded/not administered to any patient’. Use of this modifier is not permitted under MassHealth policy, as outlined in Subchapter 6 of the Provider Manual. In October 2025, MassHealth identified a system issue… Continue Reading Adjustments on Medicare Crossover Claims for Discarded Drugs

Beginning 12/21/25, the Eligibility Verification System (EVS) and Provider Online Service Center (POSC) will show key details when a member elects the MassHealth Hospice Benefit, including the hospice provider’s information (DBA, name, address, phone, PID/SL, NPI), and the member’s MassHealth and Medicare hospice enrollment dates (if available). A reminder will also appear for providers to… Continue Reading Upcoming Changes to EVS and POSC Hospice Information Display