Message Text – August 2025

MassHealth Provider Remittance Advice

The messages listed below may be general All Provider messages, applicable to several provider types or services, or provider specific. 

You can request a copy of a prior message by:

• Emailing [e-mail]
• Sending a letter to

  MassHealth Customer Service
  P.O. Box 278
  Quincy, MA 02171

• Calling MassHealth Customer Services at [phone],
  Hours: Monday through Friday 8 a.m. to 5 p.m.

08/05/2025

Reinstatement of Primary Care Referral Requirements

On March 20, 2020, as part of MassHealth’s COVID-19 response, the Executive Office of Health and Human Services suspended referral requirements for MassHealth covered services for the Primary Care Accountable Care Organizations (ACO) and the Primary Care Clinician (PCC) Plan.

Effective August 1, 2025, MassHealth is reinstating referral requirements for services provided to members in the PCC plan or a Primary Care ACO, as outlined in 130 CMR 450.118(J): Referral for Services and 130 CMR 450.119(I): Referral for Services.

For more information, please review All Provider Bulletin 403: Ending the Suspension of Primary Care Clinician Plan & Primary Care ACO Referrals and Updating Referral Requirements for Urgent Care Services: All Provider Bulletins 404-through-300.

Claims submitted to MassHealth for services that require a referral must include an authorized referring provider’s national provider identifier (NPI). The referring provider must also be enrolled with MassHealth for the claim to be payable. Billing providers must include the NPI of an authorized referring provider who is enrolled with MassHealth. This NPI must appear on every claim with a service that requires a referral for the claim to be payable.

For questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

Date published:	August 4, 2025