Frequently Asked Questions
What is the PCC Plan?
The Primary Care Clinician (PCC) Plan is a managed care health plan option run by MassHealth. MassHealth members receive primary care and other medical services through the PCC Plan.
To enroll as a PCC, you must be a fully participating, MassHealth fee-for-service (FFS) provider. You must also complete a separate PCC application and meet the requirements of the PCC Plan contract. PCC applications must be approved by MassHealth. Providers may submit a PCC Plan application with their FFS application.
Before applying, providers should review the applicable MassHealth regulations. Regulations outline the MassHealth program requirements. Please refer to Administrative and Billing Regulations (130 CMR 450.118) and the PCC Plan contract.
What provider types can participate in the PCC Plan?
Only the specific provider types and health care facilities listed below may enroll as a PCC.
- Acute outpatient hospital
- Community health center
- Group practice organization
- Hospital-licensed health center
- Certified nurse practitioner
- Physician
- Physician assistant (employed by a group practice)
All applicants should refer to Administrative and Billing Regulations (130 CMR 450.118(B) for specific details regarding PCC Plan provider eligibility.
I am a MassHealth provider. Am I automatically enrolled as a PCC?
No. There is a separate application process for the PCC Plan. For more information, go to the provider enrollment page or contact MassHealth.
How are members assigned to a Primary Care Clinician (PCC)?
Managed care eligible members are asked to choose a health plan. This may be an accountable care organization (ACO), managed care organization (MCO) or the PCC Plan. If the member does not choose a health plan, they are assigned to a health plan based on their demographics.
How does a member change PCCs?
Members may select a new PCC by calling MassHealth at (800) 841-2900, TDD/TTY 711. Transfers become effective after one business day. MassHealth does not limit the number of times that a member can change PCCs in the PCC Plan. PCC Plan members can select another health plan at any time.
If you are a PCC Plan provider who has a patient who returns to your practice even though you are not that member’s PCC of record, please allow the member to call MassHealth from your office to make a change in their PCC Plan assignment. This will help to ensure that you will be eligible for payment for services that you provide to the member in the future.
Why do claims deny for lack of PCC referral when the Eligibility Verification System (EVS) stated no referral required the last time I checked?
Enrollment in Managed Care is ongoing. Please verify eligibility before each service that you provide.
I am a practitioner providing services to members in a PCC group practice. If I leave this group, am I still a PCC provider?
No. You must enroll with another PCC group practice as a PCC provider or enroll as an individual PCC provider.
| Date published: | September 16, 2024 |
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