MassHealth Provider Services

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

MassHealth is introducing a new Electronic Data Interchange (EDI) Inquiry Request form which will be accessible on Mass.gov in order to streamline how providers submit EDI related inquiries. Beginning later this month, all MassHealth providers will be required to use this online form for billing vendor updates, direct submission requests, and issues related to submitting… Continue Reading MassHealth EDI Inquiry Online Tool

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”). The Final Rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients, healthcare providers, and payers. The Final Rule… Continue Reading Advancing Interoperability and Improving Prior Authorization Processes

In August of 2024, MassHealth implemented the following claims detections: If an Independent Nurse (IN) bills for overtime units using modifiers TU or U4 before they bill for 40 hours of standard Continuous Skilled Nursing (CSN) services in a calendar week (starting Sunday 12am and ending Saturday 11:59pm). If an IN bills for greater than… Continue Reading Duplicate Claims Suspension – Independent Nurse (IN) Providers

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)

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)