Important Note: The information on this page applies to all providers, except dental providers who are not oral or maxillofacial surgeons. Dental providers who are not oral or maxillofacial surgeons must contact the MassHealth Dental Customer Service Center at 1-800-207-5019 if they have any questions about MassHealth.
Billing Guides
- Changes to 5010 Billing Guides
- CMS-1500 Billing Guide file size 2MB
- UB-04 Billing Guide
- Residential Care Home Billing Guide for the UB-04
- EPSDT & PPHSD Billing Guidelines for MassHealth Physicians and Mid-Level Providers (PDF)
- Legacy MMIS Edit Code Explanations (PDF)
To support providers who continue to handle and process legacy MassHealth claims, this legacy edit code list will remain on the MassHealth Web site for a while. Please note that these denial codes reflect only legacy MMIS denials. - List of Explanation of Benefit Codes Appearing on the Remittance Advice (PDF)
These are EOB codes, 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. - NewMMIS Billing Tips (PDF)
- NewMMIS Billing Tips for Acute Inpatient Hospitals (PDF)
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NewMMIS Billing Tips for Chronic Disease and Rehabilitation Inpatient Hospitals (PDF) |
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- POPS Billing Guide (PDF)
- Remittance Advice for Paper Claims and Electronic Equivalents (PDF) file size 1MB
- Residential Care Home Guide to the Remittance Advice for Paper Claims and Equivalents (PDF)
- Special Instructions for Submitting Claims on the CMS-1500 for Members with Commercial Insurance (PDF)
- Special Instructions for Submitting Claims on the CMS-1500 for Members with Medicare Coverage (PDF)
- Special Instructions for Submitting Claims on the UB-04 for Members with Other Health Insurance (PDF)
Companion Guides
Please Note: When submitting electronic files to MassHealth, be sure to review the instructions in the appropriate companion guides, UB-04 and CMS-1500 Billing Guides, and billing tips flyers to determine the appropriate requirements for submitting electronic files to MassHealth.
- Changes to Companion Guides
Important! The companion guides for 5010 have been updated. Please use this document to understand the changes that have been made to the companion guides since the previous versions were issued. These changes have also been incorporated into the most recent versions of the companion guides below.
- 270/271 Companion Guide
- 276/277 Companion Guide
- 820 Companion Guide
- 834 Outbound Companion Guide
- 835 Companion Guide
- 837I Companion Guide
- 837I Residential Care Homes Companion Guide
- 837P Companion Guide
Forms That Have Been Created or Revised for Use in NewMMIS
- Preadmission Screening Form (Acute) [PAS-A] (PDF)
- Preadmission Screening Form (Chronic Rehab) [PAS-CR] (PDF)
- Prior Authorization Request [PA-1] (PDF)
- Request for MassHealth Forms [RMF] (PDF)
- Status Change for Members in a Nursing Facility or Chronic Disease and Rehabilitation Inpatient Hospital [SC-1] (PDF)
- Status Change for Residents in a Rest Home [SC-1-RH] Form (PDF)
- Sterilization Consent Form Ages 18-20 [CS-18] (PDF)
- Sterilization Consent Form Ages 18-20 - Spanish [CS-18S] (PDF)
- Sterilization Consent Form Ages 21 and Older [CS-21] (PDF)
- Sterilization Consent Form Ages 21 and Older - Spanish [CS-21S] (PDF)
- Void Request Form [VR-1] (PDF)
Healthcare Transactions Services-System-to-System Testing
If you currently submit batch transactions directly to MassHealth (270/271, 276/277, 820, 834, 835, 837) and are interested in submitting batch transactions to NewMMIS via the automated Healthcare Transactions Services (HTS) method (that is, system-to-system), please contact MassHealth Customer Service.
The NewMMIS HealthCare Transaction Services (HTS) Developers' Guide has been updated. Use this document to quickly view the latest updates to the guide. These revisions are also summarized in the developers' guide itself.
MassHealth Customer Service
1-800-841-2900
E-mail: hipaasupport@mahealth.net
Miscellaneous Publications
- A Guide to the Program of All-inclusive Care for Elderly (PACE) MassHealth Members (PDF)
- A Guide to the Senior Care Options (SCO) Program for MassHealth Providers (PDF)
- Automated Voice Response (AVR) User Guide (PDF)
- AVR Quick Reference Guide (PDF)
- Letter from the Medicaid Director to Providers about NewMMIS (PDF)
- New MassHealth Card Insert (PDF)
Transmittal Letters about NewMMIS
- ALL-169: Revised Part 6 of the Administrative and Billing Instructions (PDF)
- ALL-168: Revised Appendix C (PDF)
- ALL-167: Revised Appendix Y (PDF)
- ALL-166: Revised Appendix A (PDF)
- ALL-165: Administrative and Billing Instructions (PDF)
- AIH-45: Revised Appendix E (PDF)
- AIH-44: New Appendix D (PDF)
- AOH-22: Revised Appendix F (PDF)
- AOH-21: Appendix D (PDF)
- CDR-24: New Appendix D (PDF)
- CHC-84: Appendix E (PDF)
- DEN-82: Appendix G (PDF)
- HHA-42: New Appendix D (PDF)
- NF-54: New Appendix G (PDF)
- NF-53: Appendices D and E (PDF)
- PHY-126: Appendix I (PDF)
- PIH-17: New Appendix D (PDF)
- POD-62: Appendix E (PDF)
- STR-16: Appendix E (PDF)
This information is provided by MassHealth