News & Updates

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, May 10th, 2026, 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… Continue Reading MMIS System Outage Notice – Sunday, May 10, 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 denied in error for edit 4257 “Provider contract modifier restriction on procedure”. Corrections were implemented in MMIS, and affected Medicare crossover claims were adjusted and will appear on this… Continue Reading Mental Health Center Crossover Claim Adjustments

The MassHealth contact information listed on current drug prior authorization decision notices is incorrect. For questions or concerns about drug authorizations, please contact the MassHealth Drug Utilization Review (DUR) program at (800) 745-7318. The DUR call center is open Monday-Friday 7:30am-6:00pm and Saturday 8:00am-12:00pm.

A system release was made overnight on Thursday, April 30, 2026, to the online application at MAhealthconnector.org, (also known as the HIX system). It is recommended that following any systems release or update, Assisters or anyone using the online application (including the Assister Portal) should clear their cache or internet history before accessing the online… Continue Reading System Release Reminder for the Online Application at MAhealthconnector.org

MassHealth shared information on the new changes coming to the agency required by a federal law passed in 2025, call the One Big Beautiful Bill Act (OB3). There will be new rules for some members, including work and education requirements and more frequent renewals. Learn how these federal changes may affect MassHealth members. MassHealth Presentation… Continue Reading Spring 2026 MassHealth and Health Safety Net Updates

The Health Connector and S.H.I.N.E. program as they discuss the relationship between ConnectorCare and Medicare eligibility. MassHealth will share information of changes coming to the agency required by a federal law passed in 2025, called the One Big Beautiful Bill Act (OB3). There will be new rules for some MassHealth members, including work and education… Continue Reading Spring 2026 MA Health Care Learning Series

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 future remittance advice. If you have any questions, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.

MassHealth identified Medicare crossover claims were denying incorrectly for members enrolled in MassHealth aid category J8 “CommonHealth and QMB”. The impacted crossover claims have been reprocessed and will appear on this and subsequent remittance advices. If you have questions or concerns, please contact the following: LTSS providers: please contact the LTSS Provider Service Center at… Continue Reading Reprocessing Medicare Crossover Claims for Members with Aid Category J8

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), must be billed with at least one of the designated service codes listed in subchapter 6 of the CBHC provider manual. Claims that do not meet this… Continue Reading Community Behavioral Health Center (CBHC) Adjustments

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 help explain how federal changes may affect members and partners. Changes to MassHealth are not happening right away, and they will not affect all MassHealth members. MassHealth… Continue Reading Webinar Opportunity: MassHealth Federal Updates

Presented by MassHealth Business Support Services and Long-Term Services and Supports The Provider Services Training Series delivers key updates and guidance for MassHealth providers. We want to ensure providers come away with information that will help them successfully interface with MassHealth systems and programs to better serve MassHealth members. Topics will include: Non-LTSS provider enrollment… Continue Reading Spring 2026 MassHealth Training Forum Provider Updates

The Provider Services Training Series provided updates for MassHealth providers on enrollment self-service enhancements, referral requirements updates and reminders, the new Electronic Data Interface Assistance Request via Mass.gov, and other Mass.gov updates. Additional topics will include prior authorization reminders, dental program information, Long-Term Services and Supports (LTSS) updates, claims operation reminders, and guidance on application… Continue Reading Winter 2026 MassHealth Training Forum Provider Updates

MassHealth provided updates on MassHealth renewals, MassHealth premium schedule, End of Year tax filing process, Medicare Savings Program (MSP), 2026 Social Security Cost of Living Adjustment (COLA), CMS interoperability for members, My Account Page (MAP) for member portal, Eligibility Verification System (EVS), Program of All-inclusive Care for the Elderly (PACE), and recertification of Certified Application… Continue Reading Winter 2026 MassHealth & Health Safety Net Updates

The Health Connector provided updates on Federal Policy changes, how to help former PT1 members access services, the close of Open Enrollment for 2026, Special Enrollment Period (SEP) and qualifying life event rules. MassHealth and the Health Connector reviewed the annual process for End of Year tax filing rules. Meeting Presentation Materials Download PowerPoint Download… Continue Reading Winter 2026 MA Health Care Learning Series

Presented by the MA Office for Refugees and Immigrants (ORI) Know Your Rights 3.0 is an in-depth and comprehensive review of rules regarding ICE enforcement beyond basic warrant requirements. It includes topics such as (1) understanding when ICE may be required to show a warrant, (2) overview of the rules regarding when ICE is required… Continue Reading Winter 2026 Know Your Rights Presentation 3.0

Providers are reminded to request applications and submit them to MassHealth within a 90-day timeframe to ensure that an outdated version is not submitted for enrollment. As of January 2026, MassHealth has begun rolling out changes to its applications to include new information fields that will be displayed in the Mass.gov Provider Directory. Long-Term Services… Continue Reading Application Updates as of January 2026

List of frequently used acronyms in MTF quarterly presentations. This document is updated following each MTF quarterly session.  

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 mail or via their member portal (if they have selected the paperless option). Health Connector members use the 1095-A tax form when they prepare their federal tax… Continue Reading Health Connector Member Tax Filing Responsibilities and Where to Get Tax Filing Help

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 the first few weeks of February. To get a duplicate 1095-A form, Health Connector members can either: Download and print a copy of their form from the… Continue Reading Helping Members Access Health Connector 1095-A Tax Forms

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 approving activities and hours worked, requesting approval for PCAs to work overtime, and terminating PCAs when necessary. The Internal Revenue Service (IRS) recently determined that payments to a personal… Continue Reading Personal Care Attendant (PCA) Difficulty of Care Payments