Message Text – September 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.

09/30/2025

Revised - Provider File Update Requests by Fax Submissions are Discontinued as of October 1, 2025

As of October 1, 2025, faxed provider file update requests will not be processed (this applies to all non-LTSS and non-dental providers). Please submit your update request using the Provider Self-Service site: MassHealth Provider Self-Service.

For more information on maintaining MassHealth provider file information, visit MassHealth Provider File Information.

Providers may access Provider Enrollment and Credentialing (PEC) self-service resources training in the provider learning management system for non-LTSS and non-dental providers. The training ‘PEC Self-Service Resources’ is available at MassHealth BSS Provider Training Portal. This training will give instructions on how to submit a request for provider file updates along with other provider requests.

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

09/16/2025

Update for Quarterly Drug Code Rates Effective July 1, 2025

MassHealth has completed the rate updates for the July 1, 2025 Quarterly Drug codes. The impacted claims will be reprocessed and/or adjusted and will appear on a future remittance advice.

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

09/09/2025

Revised - Provider File Update Requests by Fax Submissions to be Discontinued Effective October 1, 2025

Effective October 1, 2025, provider file update requests for non-LTSS and non-dental MassHealth providers will no longer be accepted via fax. To ensure timely processing of your updates moving forward, please visit the Provider Self-Service site, available at MassHealth Provider Self-Service. Only updates submitted to Provider Enrollment and Credentialing (PEC) through self-service and by mail will be accepted.

Providers may access the training ‘PEC Self-Service Resources’ in the provider learning management system for non-LTSS and non-dental providers, which is available at MassHealth BSS Provider Training Portal. This training will give instructions on how to submit a request for provider file updates along with other provider requests.

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

09/02/2025

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - Exemption for Prosthetic and Orthotic SERVICES

Effective August 1, 2025, MassHealth has added prosthetic and orthotic services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, prosthetic and orthotic services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - Exemption for Therapist Services

Effective August 1, 2025, MassHealth has added therapist services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, therapist services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for CSN Agency Services

Effective August 1, 2025, MassHealth has added continuous skilled nursing (CSN) agency services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, CSN agency services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for Independent Nursing Services

Effective August 1, 2025, MassHealth has added independent nursing services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, independent nursing services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for Home Health Services

Effective August 1, 2025, MassHealth has added home health services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, home health services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Date published:	September 2, 2025
Last updated:	September 29, 2025