Handbook  MassHealth Provider Handbook

Table of Contents

• Fee-For-Service (FFS) and MassHealth Provider Network 
• MassHealth Health Plans for Managed Care Eligible Members
  • Primary Care Clinician Plan & Primary Care Accountable Care Organizations 
  • Integrated Care Plans 
  • Managed Care Organizations and Accountable Care Partnership Plans 
• Types of MassHealth Network Providers 
• MassHealth Provider Directory, Provider File Maintenance, and Revalidation 
• Provider Manuals & Regulations 
• Provider Integrity 
• MassHealth Members and Benefits 
• Third Party Liability (TPL) 
• MassHealth Authorizations and Referrals 
• MassHealth Electronic Data Interchange (EDI) 
• MassHealth Billing and Claims
  • MassHealth Claim Submission 
  • MassHealth Coordination of Benefits (COB)/Medicare Crossover 
  • MassHealth Claim Status, Reconciliation, and Additional Claims Resources 
• Payments 
• Mass.gov for MassHealth Providers 
• Provider Portals 
• Provider Resources and Communications 
• Training, Refreshers, and Important Information
  • Training and Refreshers 
  • Important Information 
  • Tips/Best Practices 
• Appendix A: Acronyms