Error message for edit 2016 has been updated to clarify denied claims where a member is enrolled in PACE/SCO. The updated message is 2016 MEMBER COVERED BY SCO/PACE PLAN – MUST BILL SCO/PACE. Providers are reminded to bill the SCO/PACE plan for services. For questions or concerns: LTSS providers, please contact the LTSS Provider Service… Continue Reading Edit 2016 Updated Error Message Description
Starting January 1, 2026, independent nurses (INs) who are seeking a prior authorization (PA) to work with a Community Case Management (CCM) member for the first time must submit a copy of a signed plan of care to the member’s CCM clinical manager in order to receive their PA for continuous skilled nursing (CSN) services.… Continue Reading Plan of Care Submission Requirements
MassHealth will be implementing a new claims detection on January 12, 2026, to ensure that dates of service (DOS) for claims submitted by independent nurses fall within one calendar week. A calendar week is defined as the hours from 12 am Sunday to 11:59 pm Saturday. This claims detection is being used to ensure that… Continue Reading New Claim Detection for Independent Nurses
Ending of ConnectorCare Plan Type 1 Effective January 1, 2026, the Health Connector’s ConnectorCare Plan Type 1 will no longer be available as a coverage option because of federal policy changes. Those previously eligible and enrolled ConnectorCare Plan Type 1 members will no longer be eligible for help paying for their coverage. Many people, because… Continue Reading Ending ConnectorCare Plan Type 1 and How to Help Members Access Services
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 28, 2025, from 3:00 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 28, 2025
MassHealth has completed the rate updates for the July 1, 2025 and October 1, 2025 Quarterly Drug Code Rates of the Community Health Center Manual. MassHealth updated its system for these drug code rate changes effective for dates of services on or after July 1, 2025, and October 1, 2025. All affected claims were reprocessed… Continue Reading Claims Reprocessed for Community Health Centers for Updated July 1, 2025 and October 1, 2025 Quarterly Drug Code Rates
MassHealth is seeing large numbers of denials for 1945 – BILLING PROVIDER NPI IS MAPPED TO MULTI SERV LOC when the NPI cannot be mapped to the correct MassHealth Provider ID/Service Location (PID/SL). Providers are reminded of the following to avoid these denials: Do not bill with a taxonomy code in the 2000A PRV03 segment… Continue Reading Claim Denials – Billing Provider HPI is Mapped to Multiple PID/SLS
Open Enrollment for 2026 is the most complex Open Enrollment the Health Connector has had in many years. To ensure our partners remain up to date with the enrollment trends we are seeing, we are pleased to be able to share a new external dashboard. This dashboard helps interested parties have real-time sightlines into Health… Continue Reading NEW: Health Connector Open Enrollment Public Dashboard
A system maintenance was made overnight on December 17th, to the online application at MAhealthconnector.org, (also known as the HIX system). It is recommended that following any system release or update, Assisters or anyone using the online application (including the Assister Portal) should clear their cache or internal history before accessing the online application or… Continue Reading System Maintenance Reminder for the Online Application at MAhealthconnector.org
The Enrollment and Payment Deadline for Health Connector Coverage Start on January 1st is Tuesday, December 23rd. If members have questions about their January 1st enrollment, need help reporting a change, or selecting a new health and dental plan, they can call the Health Connector Customer Service at: 1-877-MA-ENROLL (877-623-6765) As the Health Connector payment deadline… Continue Reading Health Connector Enrollment and Payment Deadline Approaching
