Message Text – June 2026

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

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

06/30/2026

New MMIS Edit for Children’s Medical Security Plan (CMSP) Claims

Members enrolled in Children’s Medical Security Plan (CMSP) are not eligible for CMSP coverage when they have other health insurance coverage, with the exception of members covered by MassHealth Limited. Effective for claims adjudicated on or after June 26, 2026, the claim will deny for edit 2619 ‘Member with TPL not eligible for CMSP’ if the member’s Third Party Liability (TPL) file indicates other insurance coverage on the date of service or a CMSP member’s claim contains other health insurance information.

If you have questions or concerns, please contact MassHealth at [phone] or [e-mail]. LTSS providers should contact LTSS Provider Service Center at [phone] or [e-mail].

06/16/2026

January 2026 HCPCS Code Updates to the Subchapter 6 Durable Medical Equipment Manual

The Centers for Medicare & Medicaid Services (CMS) have published the HCPCS codes for January 2026. Please reference Administrative Bulletin 26-13 for more information.

MassHealth has updated Subchapter 6 of the Durable Medical Equipment (DME) Manual to incorporate those January HCPCS service code updates, as applicable.

Please reference Transmittal Letter DME-51 for more information.

Additionally, the MassHealth Durable Medical Equipment and Oxygen & Respiratory Payment and Coverage Guideline Tool has been updated and posted on the MassHealth website.

Please refer to the Tool for HCPCS codes that have been added effective 1/1/26 and for further instructions regarding coverage, limits, and prior authorization requirements.

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

06/09/2026

ATN Revalidation Contacts: Enhanced Provider Revalidation Beginning July 1, 2026

Starting July 1, 2026, MassHealth is introducing two important updates to the provider revalidation process:

NEW REQUIREMENT - Provider Directory Information
During revalidation, you must review and submit information for the MassHealth Fee-for-Service Provider Directory. This is required under federal CMS guidelines and the Consolidated Appropriations Act, 2023.

NEW ENHANCEMENT - Simplified Process for Certain Providers
Non-Medicare participating individual providers will no longer need to log in to the POSC to review and attest to their information. Instead, you can complete this step through a secure web link included in your revalidation email.

Detailed instructions will be included in your July launch revalidation communications. For questions, please contact [e-mail].

Crossover Claim Adjustments for Behavioral Health Services

MassHealth identified certain behavioral health services provided by psychologists, licensed independent clinical social workers, or licensed independent behavioral health clinicians were reimbursed incorrectly. Corrections have been implemented in MMIS, and the affected Medicare crossover claims with dates of service on or after April 25, 2025 have been adjusted. These adjustments will appear on this and subsequent remittance advices.

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

06/02/2026

In Home Nursing Preferences Survey - Please Share Your Feedback with MassHealth

MassHealth has created a survey to collect feedback from nurses who provide in-home, continuous skilled nursing services to MassHealth members. The survey asks questions about what factors impact a nurse’s decision to work with a patient or not. Please consider taking this survey, which will provide valuable feedback to MassHealth and will inform policy development. The survey is completely anonymous.

The survey can be found at: https://tinyurl.com/b3ye2kt4 

Thank you so much for considering! Please submit survey responses by Friday, June 12. 

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

Nursing Facility Updates for Medicare Crossover and Medicare Advantage Ancillary Claims

Effective for dates of service on or after June 1, 2026, MassHealth therapy rates per regulations at 101 CMR 339.000 will be applied to Medicare crossover and Medicare Advantage claims submitted by nursing facilities for therapy services. These claims will be re-priced in accordance with TPL regulations 130 CMR 450.317 and 450.318.

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

Adjusting Certain Outpatient Hospital Drug Claims

MassHealth identified certain outpatient claims for drugs requiring prior authorization (PA), with dates of service on or after January 1, 2026, that were incorrectly denied for edit ‘3003-Procedure Code Requires PA’.

In the interim, a manual PA lookup process will be implemented, and affected claims will be adjusted and reflected on subsequent remittance advices until the permanent system automatic PA lookup is corrected in MMIS. 

Once the permanent correction to the system automatic PA lookup is implemented in MMIS, affected claims will be re-adjusted as needed to accurately reflect PA utilization. These re-adjustments are expected to occur in early October 2026.

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

Date published:	June 1, 2026
Last updated:	June 29, 2026