Changes to MassHealth PCC AND ACO Referrals

Beginning with dates of service on or after January 1, 2024, members enrolled in the Primary Care Clinician (PCC) Plan or a Primary Care ACO will need a referral from their primary care provider or primary care clinician to receive any MassHealth covered service that requires a referral, other than those exempt from the referral requirements.

For dates of service on or after January 1, 2024, claims for such services will also need to include the Referring Provider to comply with the ordering, referring, and prescribing (ORP) requirements under Section 6401(b) of the Affordable Care Act and the Referring Provider must be actively enrolled with MassHealth.

If you have questions regarding this message, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900. LTSS providers should contact the MassHealth LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.