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.
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
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
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)
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, October 26, 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, October 26, 2025
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.
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
Effective October 1, 2025, provider file update requests will not be processed (this applies to all non-LTSS and non-dental providers). Please submit your update request using the Provider Self-Service site: https://masshealth.ehs.state.ma.us/ProviderSelfService/. For more information maintaining MassHealth provider file information, visit https://www.mass.gov/info-details/maintaining-masshealth-provider-file-information. Providers may access the Provider Enrollment and Credentialing (PEC) self-service resources training in the… Continue Reading REVISED – Provider File Update Requests by Fax Submissions are Discontinued as of October 1, 2025
This message serves as a reminder to providers about the standard RMRP process. In accordance with 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), RMRP will recover MassHealth claim payments for members who have been awarded retroactive Medicare coverage when: MassHealth was the primary claims payor at the time when services were rendered, Medicare coverage is… Continue Reading Retroactive Medicare Recovery Project (RMRP)
Effective October 10, 2024, MassHealth launched two new self-service tools for MassHealth providers: a Provider Enrollment Status tool & a Provider Application Status tool. These web-based tools will assist providers and their credentialing staff with Provider Enrollment & Credentialing (PEC) inquiries. The Provider Enrollment Status tool will allow providers to verify the current enrollment status… Continue Reading Self-Service Tools for MassHealth Providers
