Provider Library

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.

MassHealth issues provider bulletins as needed to communicate procedures, reminders, and other information to MassHealth providers.

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.

These forms are used by MassHealth providers to conduct business with MassHealth.

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.

The MassHealth Companion Guides are instructions on how to bill electronically.

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.

For providers who bill using service codes, MassHealth publishes information about the service codes in Subchapter 6 of those provider manuals.

The provider manual appendices contain additional information about MassHealth for providers.

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.

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.

These are guidelines issued by nationally recognized health care organizations. MassHealth endorses these guidelines and recommends them as standards of care.

"Update" is no longer published. This link will let you view and print copies of archived issues.

These online tools provide abbreviated descriptions for service codes covered by MassHealth, identify applicable modifiers, place-of-service codes, prior-authorization requirements, service limits, and pricing and markup information.