A Providers Guide to www.mass.gov/masshealth

MassHealth recommends printing a copy or bookmarking this page on your Web browser. This can be used as a quick reference for locating the most commonly requested information by providers on the MassHealth Web site. Refer to the corresponding number, in the following list, to locate the links labeled on the home page screen shot below.

1. Information for MassHealth Providers

Information about the following can be found, in addition to other information, on the Information for MassHealth Providers Web page.

  • Provider Online Service Center (POSC);
  • New Medicaid Management Information System (NewMMIS) and the POSC;
  • clinical practice guidelines;
  • HIPAA;
  • claims submission *;
  • customer service for providers;
  • Eligibility Verification System (EVS)
  • provider forms;
  • pharmacy program;
  • Guidelines for medical necessity determination
  • enrollment and credentialing;
  • provider information maintenance; and
  • provider training.

* Contains information on claims processing data, billing information, and various invoice and claim submission forms.

2. MassHealth Regulations and Other Publications

Use the Provider Library under the MassHealth Regulations and Other Publications link to locate the following, and also other information.

  • provider manuals, including regulations, service codes, billing guides, and appendices;
  • provider forms;
  • provider bulletins;
  • transmittal letters;
  • remittance advice message text; and
  • link to receive e-mail about newsletter updates.

3. MassHealth Drug List

Access the MassHealth Drug List for

  • a list of commonly prescribed drugs and therapeutic class tables; and
  • prior authorization forms for pharmacy services.

4. MassHealth and HIPAA

For information related to electronic claims submission and Electronic Data Interchange (EDI), use the MassHealth and HIPAA link to access

  • HIPAA education and resources;
  • EDI support, education, and resources;
  • national provider identifier (NPI) information;
  • MassHealth companion guides;
  • MassHealth-approved vendor list for HIPAA-complaint electronic 837 claims.

5. Online Services

Select Online Services to

  • access the Provider Online Service Center;
  • submit claims electronically;
  • download the 835 Remittance Advice;
  • verify member eligibility through EVS;
  • choose your preferred communication method; and
  • register for training.

Additional Materials

This information is provided by MassHealth .