News & Updates

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 and Supports (LTSS) and dental providers are reminded to utilize their respective provider portals, and all other provider types should use MassHealth Provider Self-Service https://masshealth.ehs.state.ma.us/ProviderSelfService/ to… Continue Reading Application Updates as of January 2026

When Open Enrollment ends, people can still apply for health benefits; however, they can only enroll in Health Connector Qualified Health Plan (QHP) coverage if they qualify for a Special Enrollment Period (SEP). If they qualify under the rules of a SEP, they have up to 60 days from the date of the Qualifying Life… Continue Reading Special Enrollment Period (SEP) Rules

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 access to premium tax credits or ConnectorCare coverage for Plan Year 2026 and are enrolled in unsubsidized Health Connector coverage for January. How does the Health Connector… Continue Reading Health Connector Members in Delinquency Status

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 that starts on February 1, 2026. The Health Connector Customer Service Call Center will be open for support during the following times: Tuesday, January 20 – Friday,… Continue Reading Health Connector Open Enrollment Ending

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, January 25th, 2026, from 3:00 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… Continue Reading MMIS System Outage Notice – Sunday, January 25, 2026

In anticipation of the Commonwealth of Massachusetts upgrading its accounting system in mid-January, Run 100869 included expedited claims for some providers. Due to the postponement of the upgrade to mid-February, typical prudent pay rules will be back in place for Run 100870. For questions or concerns, use the contact information below: LTSS providers, please contact… Continue Reading Commonwealth of Massachusetts Accounting System Upgrade

MassHealth is requesting that providers confirm the provider’s status (enrolled or application pending) using the MassHealth Provider Self‑Service (PSS) to avoid completing and submitting duplicate applications. This is essential for third-party vendors that may not be aware of a provider’s status. The PSS can be accessed at: https://masshealth.ehs.state.ma.us/ProviderSelfService/. Please use the ‘Check Provider Enrollment Status’ and… Continue Reading Attention MassHealth Providers and Third-Party Vendors Acting on Their Behalf

If you belong to a group practice or facility that revalidates providers for MassHealth, please ensure that your organization’s revalidation contact information is current and accurate. MassHealth must be able to reach your designated contact and verify required information for your providers during the revalidation process. If revalidation contacts do not respond or complete necessary… Continue Reading Attention Needed for Outdated Revalidation Contacts

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

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 healthcare costs, including prescriptions. You can apply by completing and submitting the December 2025 version of the Medicare Savings Program (MSP) application. Due to updates from federal… Continue Reading Updates to the Medicare Savings Program (MSP) Application

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 countable income of over 150% of the Federal Poverty Level (FPL). Starting in March of 2027, MassHealth will increase premium billing amounts yearly by the same percentage… Continue Reading Increases to MassHealth Premium Billing Amount

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

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. Learning Objectives: It will include topics such as (1) understanding when ICE may be required to show a warrant, (2) overview of the rules regarding when ICE… Continue Reading Winter 2026 Know Your Rights Presentation 3.0

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

Presented by MassHealth Provider Relations and Business Services and Supports (BSS) The Provider Services Training Series offers essential information and updates for MassHealth providers. This meeting will feature updates 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… Continue Reading Winter 2026 MassHealth Training Forum Provider Updates

Presented by MassHealth and Health Safety Net MassHealth will provide the latest updates and information related to MassHealth applicants and members. Learning Objectives: MassHealth Renewal Updates Updates to MassHealth Premium Schedule 2026 Social Security Cost of Living Adjustment (COLA) New Tool for Members to Access Health Care Information Audience: All Health Safety Net will be presenting… Continue Reading Winter 2026 MassHealth & Health Safety Net Updates

Presented by the Health Connector and MassHealth The Health Connector will review information about the close of Open Enrollment, Special Enrollment Period rules and the process for End of Year tax filing. Learning Objectives: During this presentation, Health Connector and MassHealth staff will: Review information on the close of Health Connector open enrollment for 2026 Discuss… Continue Reading Winter 2026 MA Health Care Learning Series

Ending of ConnectorCare Plan Type 1 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 and enrolled ConnectorCare Plan Type 1 members will no longer be eligible for help paying for their coverage. Many people, because… Continue Reading Ending ConnectorCare Plan Type 1 and How to Help Members Access Services

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