Provider Library
MassHealth Provider Library: E-mail Notifications
If you are a MassHealth provider, use this form to sign up to receive e-mail alerts when new transmittal letters and bulletins become available. If you are not a MassHealth provider, Sign up here. Just send the blank e-mail as it is addressed. No text in the body or subject line is needed.
MassHealth Provider Regulations
The MassHealth regulations describe provider participation requirements for MassHealth. In addition to the administrative and billing regulations, which apply to all providers, MassHealth providers must comply with the regulations for the provider type for which the provider is enrolled.
Provider Bulletins
MassHealth issues provider bulletins as needed to communicate procedures, reminders, and other information to MassHealth providers.
MassHealth Provider Manuals
The MassHealth provider manuals consist of both generic (all provider) pages and provider-specific pages. If you have a question about which provider manual you should use, call 1-800-841-2900.
MassHealth Provider Forms
These forms are used by MassHealth providers to conduct business with MassHealth.
Transmittal Letters
Transmittal letters contain changes to MassHealth provider manuals. They summarize the change, contain revised pages for the provider manual, and tell providers how to update their manuals with the new pages.
MassHealth Companion Guides
The MassHealth Companion Guides are instructions on how to bill electronically.
MassHealth Billing Guides for Paper Claim Submitters
These MassHealth billing guides provide detailed information on how to complete each paper claim form that MassHealth accepts. For each billing guide, there is a corresponding guide to the applicable remittance advice and its electronic equivalents.
MassHealth Service Codes and Descriptions
For providers who bill using service codes, MassHealth publishes information about the service codes in Subchapter 6 of those provider manuals.
List of Explanation of Benefit Codes Appearing on the Remittance Advice
These are EOB codes (PDF) | CSV, revised for NewMMIS, that may appear on your PDF remittance advice. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. It has now been removed from the provider manuals and is being posted as a freestanding document. For more information on how to correct a claim, see the revised Part 6 of the administrative and billing instructions. The MassHealth provider manuals are available in the Provider Library of the MassHealth Web site.
Legacy MMIS Edit Code Explanations
To support providers who continue to handle and process legacy MassHealth claims, this legacy edit code list (PDF) | TEXT will remain on the MassHealth Web site for a while. Please note that these denial codes reflect only legacy MMIS denials.
MassHealth Provider Manual Appendices
The provider manual appendices contain additional information about MassHealth for providers.
Remittance Advice Message Text
The first page of the MassHealth remittance advice (RA) is used to send important messages to providers. These messages may contain billing, regulation, and reimbursement information, as well as other topics. These updates should be communicated to all applicable staff.
MassHealth Guidelines for Medical Necessity Determination
The MassHealth Guidelines for Medical Necessity Determination (Guidelines) are used by MassHealth's reviewing clinicians to determine the medical necessity of prior-authorization requests submitted by providers.
Clinical Practice Guidelines for MassHealth Providers
These are guidelines issued by nationally recognized health care organizations. MassHealth endorses these guidelines and recommends them as standards of care.
MassHealth Newsletter for Providers - "Update"
Sign up to receive e-mail notification when new "Update" newsletters are posted to this Web site. Note: When you follow this link, a blank e-mail will appear. Just send the blank e-mail as it's addressed. No text in the body or subject line is needed.
MassHealth Payment and Coverage Guideline Tools
These online tools provide abbreviated descriptions for service codes covered by MassHealth, identifies applicable modifiers, place-of-service codes, prior-authorization requirements, service limits, and pricing and markup information.