Procedures and Resources for Submitting Claims

MassHealth HIPAA Testing Process

Providers who wish to submit EDI HIPAA-compliant 837 Professional and Institutional claims transactions directly to MassHealth, using billing software, must successfully complete compliance testing with MassHealth before submitting production claims. Providers who contract with a billing intermediary or claims clearinghouse must ensure that their billing intermediary or claims clearinghouse has completed compliance testing successfully with MassHealth.

If you do not know if your vendor/intermediary is approved to submit EDI claims to MassHealth, or are considering using a vendor for billing purposes, please view the vendor list below, which provides a current status of approved MassHealth vendors and the type of transactions the vendor supports (for example, coordination of benefits claims as well as void and replace transactions).

This list was not created for endorsement purposes, but rather to assist providers in identifying vendors who support HIPAA-compliant claim transactions with MassHealth.

The following resources will help you prepare to process HIPAA 837 batch transactions with MassHealth.

Implementation guides
Procedures for submitting HIPAA-compliant 837 claims
Companion guides for the 837 transactions
MassHealth specifications addenda
Vendor list
Trading partner agreement
EDI Testing FAQs

If you have questions after viewing the material listed above, please Contact MassHealth Customer Service via e-mail at hipaasupport@mahealth.net or by phone at 1-800-841-2900 for assistance before or during the testing process.