Message Text – July 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.

07/29/2025

Ordering, Referring, and Prescribing (ORP) Referring Provider Edit Denials for Pharmacies billing Durable Medical Equipment (DME) and Home Infusion Services through the Medicaid Management Information System (MMIS)

The ORP referring provider national provider identifier (NPI) is not required for claims for DME and Home Infusion Services billed by pharmacies through MMIS.

To avoid denials for claims with dates of service on and after August 1, 2025, pharmacy providers should not enter the ORP referring provider’s NPI on the claims for DME and Home Infusion Services billed through MMIS.  

Pharmacy providers must include the ORP ordering provider’s NPI on the claim for DME and Home Infusion Services billed through MMIS, and the ordering provider must be actively enrolled with MassHealth as either a fully participating provider or a non-billing authorized ORP provider for the claim to be payable.

Providers should review referring and ordering provider informational edits on their remittance advices and update billing processes to ensure compliance with ORP requirements.

For more information, please refer to All Provider Bulletin 286 (with updated information provided in All Provider Bulletins 361, 376, 380, and 391) at All Provider bulletins.

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

07/22/2025

Change in phone prompts for customer service

Effective 9/1/2025, the MassHealth Customer Service phone prompts will be changing. Providers will be required to enter their MassHealth Provider ID (PID) to connect with a Customer Service Agent.

If you are unsure of your MassHealth Provider ID (PID), please visit the Provider Self Service website and perform a Provider Enrollment Status check using your NPI. If you are a MassHealth enrolled provider, this will display your Provider ID and Service Location (PID/SL). Please note that for the current prompts we are only requiring the numerical portion to be entered, the 9-digit PID, and not the letter that corresponds to the service location.

You can access the Provider Enrollment Status check on Mass.gov. 

Reminder of Ordering, Referring, Prescribing (ORP) Provider Requirements

As described in All Provider Bulletin 286 (with updated information provided in All Provider Bulletins 361, 376, 380, and 391), claims submitted to MassHealth for services that require an order, referral or prescription must include the national provider identifier (NPI) of an authorized ordering, referring or prescribing (ORP) provider. The ORP provider must also be enrolled with MassHealth for the claim to be payable.

Enter the ORP provider’s NPI in the Referring Provider field/segment if the claim 1) is for a service that requires a Primary Care Clinician (PCC) or Primary Care Accountable Care Organization (PCACO) referral; or 2) is for a laboratory service or a diagnostic testing service; or 3) is submitted on an 837I or UB-04 (such claims only have a Referring Provider field). Please note that an ORP provider’s NPI is only required on an 837I or UB-04 when the ORP provider is different than the Attending Provider. Enter the ORP provider’s NPI in the Ordering Provider field for all other impacted claims.

All Provider Bulletin 286 (and all of the referenced Bulletins) can be found on Mass.gov at: All Provider bulletins.

If you have questions, please contact MassHealth at [phone] or [e-mail].

07/01/2025

Early Intervention Telehealth Modifiers 93, FQ, and FR

MassHealth has updated codes T1015, T1023, T1024, T1027 to allow telehealth modifiers 93, FQ, and FR. Claims submitted by Early Intervention providers that were denied due to the use of these modifiers will be reprocessed and/or adjusted and will appear on a future remittance advice.

If you have questions, please contact MassHealth at [phone] or [e-mail].

Date published:	June 2, 2025
Last updated:	July 21, 2025