You will need to complete and submit the DME Authorization Request Form found in Section 15 of the Provider Manual. This requests information specific to the requesting provider, member, dates of service requested, PCP name and contact information, and diagnosis information.

Call the BMC HealthNet Plan Member Services Call Center. A representative will provide information on the closest location or make arrangements for the member.

Specialty care managers can be contacted about any case or treatments including those that may indicate a complex medical condition. The Care Management Department telephone number is 1-866-853-5241.

For pharmacy issues related to a specific prescription, call the Provider Line at 1-800-900-1451 or 1-888-566-0008. If the issue involves prior authorization or medical necessity decisions, you should check the pharmacy section of the Plan's website or call the NMHCrx Help Desk  at 1-800-510-8980.

Either you or the member can call the Member Services Call Center at 1-888-566-0010 (for members who speak English or other languages), 1-888-566-0012 (for Spanish-speaking members) or 1-866-765-0055 (for deaf and hearing-impaired members - TTY/TDD line) .

Have the member call the Member Services Call Center at 1-888-566-0010 ( for members who speak English or other languages ), 1-888-566-0012 ( for Spanish-speaking members) or 1-866-765-0055 (for deaf and hearing-impaired members - TTY/TDD line). A representative can assist the member and speak with the pharmacy.

A written prescription, or a phoned-in prescription is required for all medications, including OTCs.

Members may be able to request non-emergent transportation through MassHealth. We can also help facilitate this process. Claims processing and authorizations for non-emergent transportation are administered by MassHealth. However, this service can be arranged by a Plan Community Resource Care Manager by contacting the Plan's Care Management Department at 1-866-853-5241.

Have the member call the Member Services Call Center 1-888-566-0010 ( for members who speak English or other languages), 1-888-566-0012 ( for Spanish-speaking members) or 1-866-765-0055 ( for deaf and hearing-impaired members - TTY/TDD line) for a corrected card.

If you’re not the member’s PCP, you should direct the patient to the appropriate PCP’s office.

If the patient must be seen, you should contact his or her PCP to make sure they are aware of the visit.

You will need to appeal the claim denial by submitting a written explanation that details why the member’s eligibility was not verified prior to services being rendered.

You should always verify member eligibility at the time of service to ensure coverage. If this is done, you will be provided with the Plan’s number and you should make sure that you are the PCP for primary care services. As long as the member’s eligibility is verified on the date of service, we will pay associated claims. If you are a specialist and the service being rendered requires prior authorization, you will need to contact the member’s PCP to seek authorization.

In most cases, the requirements of MassHealth are the same as the Plan. As a result, if you provide invoices to MassHealth for a code, it is best to supply one to the Plan to ensure clean claims processing.

Yes, but with most J codes, you’ll need to submit the supplying company’s invoice for us to determine appropriate payment. Additionally, when billing immunizations, it is important to bill the antigen since payments will not be made on claims submitted with only the administration code.

Claims can combine the injection and serum as long as a supplier’s invoice is attached to ensure appropriate payment rates.

The plan dispenses in 30-day supply increments.

Yes. There can be multiple dates on one claim, but not a date range. See Section 10  of the Provider Manual for billing guidelines.

Yes, but it is required that the claim be submitted with a supplier’s invoice for each serum since this is the basis of pricing.

See Section 3 of the Provider Manual for the utilization management timeline policy.

The Plan uses the different ID numbers to identify the unique location of a medical record. This level of detail is required for HEDIS and other measures of Plan performance.