Fee-for-Service Providers
MassHealth offers benefits to members on a fee-for-service (FFS) basis or through managed care plans. MassHealth FFS network providers are enrolled in MassHealth and have agreed to furnish medical services and to participate in MassHealth under a provider contract with the MassHealth program. Review the provider types eligible to participate in MassHealth, and the regulations governing them, before applying.
MassHealth determines provider eligibility in accordance with MassHealth regulations, including but not limited to 130 CMR 450.212. If MassHealth determines that the applying provider is eligible to be enrolled, the applying provider is typically enrolled within 30 days after submitting a complete application. Make sure all the fields on your application are accurate; this way we shouldn’t need to contact you for clarification or additional documents, and we may be able to enroll you more quickly. You can learn more online about applying to MassHealth and requesting an application.
Each person, entity, or group practice enrolled as a MassHealth provider has a unique Provider Identification/Service Location (PID/SL). We suggest that you have your PID/SL on hand when logging into the Provider Online Service Center (POSC), contacting MassHealth Customer Service, or accessing Provider Self-Service. You’ll still need to use your national provider identifier (NPI) to conduct billing and Health Insurance Portability and Accountability Act (HIPAA) transactions.
Under the FFS model, MassHealth pays providers directly for each covered service received by an eligible member. FFS providers use the POSC to submit claims in MassHealth’s Medicaid Management Information System and perform other functions described in this handbook.
All MassHealth providers are required to maintain adequate documentation and records, such as their MassHealth PID/SL, in accordance with MassHealth regulation 130 CMR 450.205.
Ordering, Referring, and Prescribing
Section 6401(b) of the Patient Protection and Affordable Care Act of 2010 (ACA) includes requirements related to ordering, referring, and prescribing (ORP) providers. If MassHealth requires a service to be ordered, referred, or prescribed, then ACA Section 6401(b) requires that the billing provider include the ORP provider’s NPI on the claim and the ORP provider be enrolled with MassHealth in order for the claim to be payable. For a list of eligible ORP provider types; the services that require ORP; and provider types authorized to order, refer, or prescribe, please refer to our web page on Section 6401 of the ACA.
Qualified Medicare Beneficiary Providers
A Qualified Medicare Beneficiary (QMB)–only provider provides medical services only to the following.
- MassHealth Medicare Savings Program members described in 130 CMR 519.010 and in 130 CMR 505.007
- Certain MassHealth Standard members who are eligible for QMB benefits described in 130 CMR 519.002(A)(4)(c) and 130 CMR 505.002(O)
QMB-only providers are subject to all regulations pertaining to providers participating in MassHealth, except as otherwise specified in 130 CMR 450.000: Administrative and Billing Regulations. QMB-only providers should review MassHealth regulations before providing any services to QMB members.
Office of Long Term Services and Supports
MassHealth’s Office of Long Term Services and Supports provides a system of care for members of all ages who need services to help them live independently, participate in their communities, and increase their overall quality of life. Members receive this care through home- and community-based long-term services and supports (LTSS) and facility-based LTSS. They also receive other covered services through integrated care plans and managed care organizations. You can apply to be an LTSS provider through the LTSS provider portal.
MassHealth Dental Program
MassHealth pays for dental care for children and adults who are eligible for MassHealth, the Health Safety Net, and the Children’s Medical Security Plan. The MassHealth Dental Program regulations at 130 CMR 420.000: Dental Services and 450.105 describe dental benefits, service limitations, and member eligibility.
To view MassHealth covered dental services, please see Subchapter 6 (Dental Service Codes) of the Dental Manual.
Providers interested in participating as dental providers should visit the web page for the MassHealth Dental Program for more information, including how to apply.
| Date published: | July 29, 2022 |
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| Last updated: | August 21, 2026 |