The Massachusetts Health Care Training Forum (MTF) sends out regular email updates on current program and policy information, meeting notices, learning opportunities and other relevant information and resources.
For more information about the Provider Services notices (manage claims and payment information), please visit MassHealth Provider Remittance Advice Message Text.
Overpayments Resulting from Duplicate Claim Editing Issue
MassHealth has identified an editing issue that has resulted in overpayments for several providers. The issue has been corrected, and we are in the process of identifying affected claims for a Mass Adjustment to recoup the overpayments. As a reminder, duplicate billing is forbidden according to MassHealth Billing Regulation 130 CMR 450.302: Unacceptable Billing Practices.… Continue Reading Overpayments Resulting from Duplicate Claim Editing Issue
Health Connector Open Enrollment Starts 11/1/25 & Health Connector Partner Resources
The Health Connector’s Open Enrollment for 2026 Coverage Starts Tomorrow – Saturday, November 1st. Open Enrollment is the time of year when individuals and families can enroll in the Health Connector’s non-group health insurance coverage or switch existing coverage for any reason, without needing a qualifying event. This year’s Open Enrollment is November 1, 2025,… Continue Reading Health Connector Open Enrollment Starts 11/1/25 & Health Connector Partner Resources
Update For Quarterly Drug Code Rates Effective October 1, 2025
MassHealth has completed the rate updates for the October 1, 2025, Quarterly Drug codes. The impacted claims will be reprocessed and/or adjusted and will appear on a future remittance advice. If you have questions, please contract MassHealth at provider@masshealthquestions.com or (800) 841-2900.
Reprocess Medicare Crossover Claims Incorrectly Denied with Edit 2502
MassHealth identified an issue affecting Medicare crossover claims billed for services that are unrelated to a hospice member’s terminal illness. These crossover claims were incorrectly denied for edit 2502 ‘Member covered by other insurance’ for members enrolled in a Medicare Advantage plan on the date of service. The affected crossover claims with dates of services… Continue Reading Reprocess Medicare Crossover Claims Incorrectly Denied with Edit 2502
Changes to MassHealth’s Accountable Care Organizations on January 1, 2026
As part of MassHealth’s annual Accountable Care Organization (ACO) program update process, there will be changes to ACO service areas, hospitals, providers, and health plans within the managed care program effective January 1, 2026. Please reference All Provider Bulletin 410 at https://www.mass.gov/lists/2025-masshealth-provider-bulletins for more details. For questions or concerns: LTTS providers, please contact the LTSS… Continue Reading Changes to MassHealth’s Accountable Care Organizations on January 1, 2026
Electronic Visit Verification (EVV) Match Informational Explanation of Benefits (EOBS)
MassHealth EVV soft edits are now live, and you may see new EVV messages on your Remittance Advice (RA). For claims for EVV services processed through MassHealth, you may begin to see codes on your RA indicating whether a matching EVV visit was found in the Sandata EVV Aggregator for the EVV service on the… Continue Reading Electronic Visit Verification (EVV) Match Informational Explanation of Benefits (EOBS)
Springfield MassHealth Enrollment Center (MEC) Moving
Springfield MEC Moving on October 24, 2025 New Address: 243 Cottage Street, Springfield Springfield MEC Moving Information
Reprocess Behavioral Health Urgent Care (BHUC) Claims Incorrectly Denied with Edit 5125
MassHealth identified an issue with affecting BHUC claims which caused claims to deny incorrectly with edit 5125 ‘Missing procedure on BHUC bundle claim’. The affected BHUC claims have been reprocessed and will appear on subsequent remittance advices. If you have questions regarding this message, please contract MassHealth at (800) 841-2900 or provider@masshealthquestions.com.
Advancing Interoperability and Improving Prior Authorization Processes
On January 17, 2024, the Centers for Medicare and Medicaid Services (CMS) issued the Advancing Interoperability and Improving Prior Authorization Processes Final Rule. The final rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients (members), healthcare providers, and payers. The rule also focuses on… Continue Reading Advancing Interoperability and Improving Prior Authorization Processes
MassHealth & Health Safety Net Updates
Presented by MassHealth and Health Safety Net MassHealth will provide the latest updates and information related to MassHealth applicants and members. In addition, you will learn about In the Loop – Massachusetts, a private online community run by Health Care For All for enrollment assisters to interact with others doing similar work. When you join In… Continue Reading MassHealth & Health Safety Net Updates