MassHealth has communicated to all plans that 2024 claims must be adjudicated by July 31, 2025. Therefore, all providers must submit claims with a 2024 date-of-service no later than July 1, 2025, to meet this adjudication deadline. This does not change/impact timely filing limits, which still apply.
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You may chat live with a claims representative by logging in to Provider Express or by calling the number on the back of the member's ID card (also available on the Explanation of Payment/Provider Remittance Advice).
Best Practices Guidelines
Coordination of Care Flyer
Coordination of Care Checklist Network Manual
Mass General Brigham Health Plan Provider Manual Addendum
Outpatient Telehealth Billing Quick Reference Guide
Standard Clinical Criteria
Suspension of Utilization Review
Welcome Massachusetts: Quick Reference Guide
Effective 11/1/23 - Harvard Pilgrim Health Plan will no longer be managed by Optum More >
Schedule an online HIPAA-compliant appointment with a member of our Outpatient Care Engagement team.
MassHealth has communicated to all plans that 2024 claims must be adjudicated by July 31, 2025. Therefore, all providers must submit claims with a 2024 date-of-service no later than July 1, 2025, to meet this adjudication deadline.
This does not change/impact timely filing limits, which still apply.
You may chat live with a claims representative by logging in to Provider Express or by calling the number on the back of the member's ID card (also available on the Explanation of Payment/Provider Remittance Advice).
Claim Billing Guide – Billing under Supervision
MA BHCA Provider FAQ
One Care Medicare-Medicaid Plan Provider Training
United Behavioral Health BHCA Provider Training: Phase 2
Massachusetts Authorization/Notification, Assessment and Treatment Forms
Applied Behavior Analysis Services Prior Authorization Request Standard Form
Massachusetts One Care BH Day Treatment Authorization Form
For more information and forms visit Guidelines/Policies & Manuals and Frequently Accessed Forms pages.
Billing Guidance and FAQ
Bundled Billing Specs
Certified Peer Support Benefit
Recovery Coach Benefit
21st Century Cures Act MassHealth Enrollment Frequently Asked Questions
