MassHealth Provider Services

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

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

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

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 

Effective Sunday, October 20, 2024, the Virtual Gateway (VG) is implementing changes to ensure that the VG and the recently implemented Multi-Factor Authentication (MFA) profile updates via Azure are synchronized. As of October 20, the VG will require that profile changes to the user’s first name, last name, and email address must only be submitted… Continue Reading Virtual Gateway Multi-Factor Authentication (MFA) Profile Updates & Transition 

Based on feedback received from providers and Community Case Management (CCM) families, CCM and MassHealth Office of Long Term Services and Supports (OLTSS) have been working on updating the CCM Nurse Directory with new enhancements. These enhancements are aimed at providing a better user experience to help each Continuous Skilled Nursing (CSN) provider and family/member register and… Continue Reading CCM Nurse Directory Updated Platform Live Now! 

MassHealth identified an issue affecting some acute outpatient hospital claims that were processed under the Enhance Ambulatory Patient Group (EAPG) pricing methodology when another payer made a payment and/or applied a patient responsibility to the claim. MassHealth corrected the issue, and the fix was implemented in MMIS on 6/9/2024. Claims adjudicated from 11/19/2023 to 6/9/2024… Continue Reading Adjustments of Acute Outpatient Hospital Claims with Coordination of Benefits (COB) Information 

Effective September 1, 2024, MassHealth will no longer be able to support claims status inquiry calls. To determine if a claim is paid, denied, or suspended, you are encouraged to use the self-service options available.  Visit https://www.mass.gov/how-to/check-claim-status to explore available self-help tools.