MassHealth Provider Services

Effective January 30, 2026, Provider Directory update requests will be available through MassHealth Provider Self-Service. Providers are required to maintain accurate profiles and update their Directory information whenever changes occur. This update allows providers to modify details such as telehealth availability, languages spoken, accessibility accommodations, website URL, and whether they are accepting new patients. CMS… Continue Reading Provider Directory Self-Service Update – Coming January 2026

MassHealth is updating the Service Codes and Descriptions (Subchapter 6) of the Physician and Acute Outpatient Hospital Manual to incorporate drug codes as well as HCPCS/Current Procedural Terminology (CPT), as applicable. MassHealth updated its system to reflect the changes effective for dates of service on or after July 1, 2025. All affected claims will be… Continue Reading Claims Reprocessed for July 2025 Subchapter 6 Code Updates

Effective January 1, 2026, prior authorizations (PAs) for the medical benefit will be adjudicated as outline below: Standard PA requests: A decision will be provided within seven calendar days from the date received, provided all necessary documentation is included. Expedited PA request: A decision will be provided within 72 hours when the member’s clinical condition… Continue Reading Update: Advancing Interoperability and Improving Prior Authorization Processes

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

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