MassHealth Provider Services

Updates to the Application for Health and Dental Coverage and Help Paying Costs (ACA-3) and Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2).

Prior authorization (PA) is not required for the services listed in Subchapter 6 of the MassHealth Renal Dialysis Clinic Manual, including CPT code 90999. Please do not submit...

Providers may now access the MassHealth Provider Handbook as a newly available resource on Mass.gov, and as a compliment to provider regulations.

On June 25, 2026, the Supreme Court issued a decision allowing the Trump administration to terminate Temporary Protected Status (TPS) for Haiti and Syria. The decision is not...

MassHealth providers, Billing Intermediaries, and Software Vendors are reminded that submitters may use replacement transactions to adjust paid claims only. If the submitter is trying to correct a...

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, September 13, 2026,...

MassHealth identified certain Mental Health Center crossover claims with dates of service on or after September 1, 2025, were reimbursed incorrectly. In addition, some crossover claims

MassHealth identified certain outpatient claims for drugs requiring prior authorization (PA), with dates of service on or after January 1, 2026, that were incorrectly denied for edit '3003-Procedure...

A system release was made overnight on Thursday, April 30, 2026, to the online application at MAhealthconnector.org, (also known as the HIX system).

MassHealth has completed the rate updates for April 1, 2026, Quarterly Drug codes. The impacted claims will be reprocessed and/or adjusted and will appear on a...

Applicants and members who receive affordable employer-sponsored insurance (ESI) are not eligible for Advanced Premium Tax Credits (APTCs). If an applicant or member is not offered ESI or...

MassHealth requires members to enroll in health insurance they have access to that's at no cost to them, including Medicare. This is because MassHealth is the payer of...

The federal government recently passed a budget reconciliation bill on July 4, 2025. As a result, many Health Connector members will see increases in the cost of their...

As a result of a recent court decision and guidance from the Centers for Medicare and Medicaid Services (CMS), the Health Connector is extending the timeline of Open...

Preliminary eligibility notices for the Health Connector's 2027 Open Enrollment are being mailed to members - now through mid-September. Some members may have already received their notices. ...

Notices for Health Connector Redetermination are Being Mailed! Preliminary Eligibility notices for the Health Connector's Open Enrollment 2026 are now being sent to members through mid-September. Some members...

Learn more about Springfield MassHealth Enrollment Center (MEC) Moving.

Starting January 1, 2026, individuals with income below 100% of the Federal Poverty Level (FPL) will no longer qualify for Advance Premium Tax Credits (APTCs) and ConnectorCare coverage....

Effective 1/1/2026, the following network changes will be in place for the Tufts Direct plan members. Please note, these changes may not reflect the full scope of provider...

The Health Connector has promotional materials, online shopping tools and downloadable member resources - in many languages - to help people make decisions about their health insurance coverage...

Open Enrollment for 2026 is the most complex Open Enrollment the Health Connector has had in many years. To ensure our partners remain up to date with the...

Effective January 1, 2026, the Health Connector's ConnectorCare Plan Type 1 will no longer be available as a coverage option because of federal policy changes. Those previously eligible...

As of January 1, 2026, MassHealth is increasing monthly premium billing amounts by 10%. MassHealth expects the increase is between $2 - $10 per month for members with...

The Medicare Savings Program (MSP) helps eligible Medicare beneficiaries pay their Medicare costs. MSP is not insurance plans. They are programs that help lower Medicare premiums and other...

Learn more about Community Behavioral Health Center (CBHC) Adjustments.

The Health Connector's Open Enrollment period is ending Friday, January 23, 2026, and is the deadline for individuals and families to apply, shop, and enroll into a plan...

Health Connector members that are enrolled in a plan for January but have not yet paid for that coverage are considered delinquent. This may include individuals that lost...

MassHealth's Personal Care Attendant (PCA) Program is self-directed, which means the MassHealth member is responsible for recruiting, hiring, training, scheduling, and managing their PCA. This includes reviewing and...

1095-A tax forms were mailed at the end of January to anyone who had health insurance through the Health Connector in 2025. Members should receive their forms during...

Each January, the Health Connector prepares tax forms for members enrolled in Health Connector health plans during the previous calendar year. They receive a 1095-A tax form in...

The federal government is making changes that impact how Medicaid (MassHealth) is funded and who can use the program. MassHealth is watching federal actions closely. We're here to...

MassHealth identified that certain CBHC claims were incorrectly billed resulting in improper payments. CBHC claims billed for an encounter bundle with the CBHC per diem service code (T1040),...

Springfield MEC Moving on October 24, 2025 New Address: 243 Cottage Street, Springfield Springfield MEC Moving Information