MassHealth Provider Services

MMIS application, EVS and all eligibility services will be unavailable on Sunday, November 23rd, 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 any inconvenience this may cause. Providers who have questions should contact MassHealth Customer Service… Continue Reading MMIS System Outage Notice – Sunday, November 23, 2025

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

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

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)

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

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 1, 2024, the MMIS and Virtual Gateway (VG) will begin deactivating accounts that have been inactive for more than 12 months. The initial deactivation event will affect accounts that have not been used since November 1, 2023. Following this initial deactivation event, accounts will be continually monitored for inactivity and subsequently deactivated in… Continue Reading Virtual Gateway Inactive Account Deactivation