News and Notices

Read provider notices, network notifications, and newsletters below.

Title Date
AMM Provider Tip Sheet, July 23, 2019
7/23/2019
BMC HealthNet Plan July Notifications, July 31, 2019
7/30/2019
Change to Medicaid National Correct Coding Initiative, July 31, 2019
7/30/2019
Formulary-update-email-posted
4/30/2019
Pharmacy benefit updates (ConnectorCare/QHP), April 29, 2019
4/29/2019
Four clinical policies updated, February 25, 2019
2/25/2019
HEDIS medical records request, January 30, 2019
1/30/2019
Include fax number with electronic prior authorizations, May 9, 2019
5/9/2019
Pharmacy benefit updates (MassHealth), April 29, 2019
4/29/2019
PCP Behavioral Health Toolkit, July 23, 2019
7/23/2019
Pharmacy benefit updates, March 4, 2019
3/4/2019
Submit prior authorization requests electronically with attachments, April 24, 2019
4/24/2019
Three clinical policies updated, May 1, 2019
5/1/2019
Pharmacy prior authorization updates, April 1, 2019
4/1/2019
Clinical trials billing/home health agencies/non-Medicare home health agency, May 1, 2019
5/1/2019
TriZetto manages all EDI transactions, April 25, 2019
4/25/2019
HEDIS Communication, June 7, 2019
6/7/2019
Medication Reconciliation Communication, July 1, 2019
7/1/2019
Modifier reimbursement policy, March 8, 2019
3/8/2019
Neulasta coverage change, May 1, 2019
5/1/2019
Pharmacy Benefit Updates, July 1, 2019
7/1/2019
Prenatal Care and Substance Use Disorder, July 1, 2019
7/1/2019
Reimbursement Policy Updates, July 1, 2019
7/1/2019
Six Clinical Policies Updated, July 1, 2019
7/1/2019
Seven reimbursement policies updated, April 1, 2019
4/1/2019
Depression webinar materials available, April 11, 2019
4/11/2019
Five clinical policies updated, January 18, 2019
1/18/2019
Prior Authorization and Billing Changes, June 1, 2019
5/29/2019
Receiving your Explanation of Payment, January 14, 2019
1/14/2019
Member eligibility – 270/271 batch transaction update, March 13, 2019
3/13/2019
Checking claim status and member eligibility, January 10, 2019
1/10/2019
Four clinical policies updated, December 26, 2018
12/26/2018
Reimbursement policies updated, December 17, 2018
12/17/2018
Prior authorization required for Cologuard, December 4, 2018
12/4/2018
Pharmacy benefit update, November 1, 2018
11/1/2018
Six clinical policies updated, October 25, 2018
10/25/2018
Conference: Caring for Adolescents in Challenging Times, March 14, 2019
3/14/2019
Seven clinical policies updated, September 29, 2018
9/29/2018
Eight clinical policies updated, September 26, 2018
9/26/2018
Reimbursement policies updated, September 25, 2018
9/25/2018
For PCPs: Community Partners training, September 10, 2018
9/10/2018
Billing Instructions for Claims Containing Gender/Procedure Conflict Network Notification released, September 1, 2018
9/1/2018
Pharmacy benefit update, September 1, 2018
9/1/2018
Correction Network Notification/new reimbursement policy/updated reimbursement policy, August 1, 2018
8/1/2018
BH Home Health Frequently Asked Questions, July 30, 2018
7/30/2018
Pharmacy benefit update, July 10, 2018
7/10/2018
MassHealth and Senior Care Options Network Notifications released, June 26, 2018
6/26/2018
Resource for parents of kids with substance use disorders, June 25, 2018
6/25/2018
Four clinical policies updated, June 25, 2018
6/25/2018
PCPs: Community Partners Program launches, June 19, 2018
6/19/2018
SCO, MassHealth and Qualified Health Plan notices, May 29,2018
5/29/2018
One clinical policy updated, May 21, 2018
5/21/2018
Pharmacy benefit update, May 11, 2018
5/11/2018
Reimbursement and medical policies notice, April 23, 2018
4/23/2018
Message from the Health Connector Regarding New Health Plan Options, April 11, 2018
4/11/2018
Prior-authorization inquiries, March 30, 2018
3/30/2018
Check the status of claims via our HealthTrio provider portal, March 20, 2018
3/20/2018
Benefit year/authorization changes, March 9, 2018
3/9/2018
Pharmacy benefit update, March 1, 2018
3/1/2018
General Buprenorphine Waiver Trainings, March 21, 2019
3/21/2019
Special Kids Special Care program, March 1, 2018
3/1/2018
Reimbursement and Clinical policies updated, February 26, 2018
2/26/2018
Two clinical policies updated, January 19, 2018
1/19/2018
SCO plan is where you are, January 18, 2018
1/18/2018
Accountable Care Organization update, January 18, 2018
1/18/2018
Pharmacy benefit update, January 9, 2018
1/9/2018
Three clinical policies updated, January 2, 2018
1/2/2018
Provider Manual updated, March 22, 2019
3/22/2019
Wait times for appointments, March 25, 2019
3/25/2019
Pharmacy benefit update, February 27, 2019
2/27/2019
Nine clinical policies updated, March 26, 2019
3/26/2019
HEDIS medical records request, March 27, 2019
3/27/2019
Home care services authorization, January 22, 2019
1/22/2019
Second notice – HEDIS medical records request, March 27, 2019
3/27/2019
Nine clinical policies updated (CORRECTED), April 1, 2019
4/1/2019
Title Date
CMS-1500 claim form network notification, February 24, 2014
2/24/2014
Pharmacy benefits update, August 22, 2017
8/22/2017
Network Notification #166 Billing Change for Vision Hardware for Qualified Health Plan Members, November 1, 2016
11/1/2016
Four medical policy updates, July 23, 2014
7/23/2014
Reimbursement policy updates, October 1, 2016
10/1/2016
Five clinical policies updated, September 28, 2017
9/28/2017
Four clinical policies updated, October 26, 2017
10/26/2017
One SCO reimbursement policy updated, November 2, 2017
11/2/2017
Pharmacy benefit update, November 9, 2017
11/9/2017
Annual SCO Model of Care training, November 13, 2017
11/13/2017
New specialty pharmacy Network Notification, November 14, 2017
11/14/2017
Medicaid ACO reform training, November 15, 2017
11/15/2017
Please notify us when information changes, November 16, 2017
11/16/2017
Five clinical policies updated, November 22, 2017
11/22/2017
Pharmacy benefit update, November 28, 2017
11/28/2017
Pharmacy benefit update, October 21, 2016
10/21/2016
Wait times for appointments, December 11, 2017
12/11/2017
Reimbursement polices updated, December 18, 2017
12/18/2017
ACA 1202 payments ended on 12/31/2014, January 15, 2015
1/15/2015
Pharmacy benefit update, December 18, 2017
12/18/2017
Five medical policies updated, May 21, 2015
5/21/2015
Baycare Health Partners Transition, November 11, 2014
11/11/2014
Pharmacy benefit update, September 15, 2016
9/15/2016
Reimbursement policies updated, December 15, 2016
12/15/2016
CAQH ProView System update, September 1, 2015
9/1/2015
ICD-10 diagnosis codes, claims editing software and site differential, March 14, 2014
3/14/2014
Two medical policies updated, December 21, 2016
12/21/2016
Medical policies updated; claims editing software updated; reimbursement policies updated, March 25, 2015
3/25/2015
Five medical policies updated, July 19, 2016
7/19/2016
Six medical policies updated, March 23, 2016
3/23/2016
Provider Manual reminder, March 23, 2016
3/23/2016
Seven policy updates, February 21, 2014
2/21/2014
Nine policy updates, January 24, 2014
1/24/2014
Notice regarding Network Notification #M-160 Drug Screen Code Update - ICD-10 Guideline Clarification, July 27, 2015
7/27/2015
Diabetes standards adopted, March 4, 2016
3/4/2016
Drug code billing Network Notification and perinatal depression screening, June 23, 2016
6/23/2016
Pharmacy benefit update, July 6, 2015
7/6/2015
Pharmacy benefit update CORRECTED, November 16, 2017
11/16/2017
Pharmacy benefit update, March 3, 2016
3/3/2016
Pharmacy benefit update, July 19, 2016
7/19/2016
Four medical policies updated, November 23, 2015
11/23/2015
Pharmacy Benefit Update, March 5, 2015
3/5/2015
Seven medical policies updated, February 25, 2015
2/25/2015
Pharmacy benefit update, May 6, 2016
5/6/2016
Pharmacy benefit update, September 4, 2015
9/4/2015
Pharmacy benefit update, November 2, 2015
11/2/2015
ICD-10 claim submission guidelines and postpartum depression billing Network Notification, May 29, 2015
5/29/2015
Two medical policies updated, June 19, 2015
6/19/2015
New specialty pharmacies, January 30, 2015
1/30/2015
Drug screening/testing, June 5, 2014
6/5/2014
Clinical policy updated, August 26, 2016
8/26/2016
Pediatric Pain Clinic opens, March 9, 2015
3/9/2015
Program updates effective January 31, 2015
1/31/2015
Commonwealth Care extended to 12/31/14, June 23, 2014
6/23/2014
Hyperbaric oxygen therapy policy, April 2, 2014
4/2/2014
HealthTrio Connect provider portal update, March 7, 2016
3/7/2016
NICU reimbursement policy and policies review, June 25, 2015
6/25/2015
Clinical policy updated, August 26, 2016
8/26/2016
Paper/electronic remittance advices network notification, April 16, 2014
4/16/2014
Two new Network Notifications: Changes to Provider Manual and MassHealth acute hospitalization coverage, November 18, 2014
11/18/2014
Senior Care Options, January 8, 2016
1/8/2016
Fifteen medical policies updated, December 11, 2014
12/11/2014
Six reimbursement policy updates, September 30, 2014
9/30/2014
Four medical policies updated, July 20, 2015
7/20/2015
Clinical practice guidelines endorsed, September 20, 2016
9/20/2016
ICD-10 prior authorization guidelines Network Notification, June 4, 2015
6/4/2015
Section 1202 PCP rate increase, April 1, 2014
4/1/2014
Network Notification #161; place of service update; and new reimbursement policy, November 1, 2015
11/1/2015
Regional offices closing, March 15, 2016
3/15/2016
Four medical policies updated, October 21, 2015
10/21/2015
Reimbursement policies updated and sleep study Network Notification released, December 22, 2014
12/22/2014
Four medical policies updated, April 25, 2016
4/25/2016
Five medical policies updated, June 20, 2016
6/20/2016
Pharmacy benefit updates, January 1, 2017
1/1/2017
Clinical practice guidelines endorsed, January 10, 2017
1/10/2017
Four clinical policies updated, November 21, 2016
11/21/2016
2017 CPT codes, January 20, 2017
1/20/2017
Twelve medical policies updated, January 31, 2017
1/31/2017
Nine medical policies updated, February 25, 2017
2/25/2017
Provider Manual reminder, March 6, 2017
3/6/2017
Primary and specialty care wait times, March 21, 2017
3/21/2017
Claims editing software reminder, March 23, 2017
3/23/2017
Eight medical policies updated, March 28, 2017
3/28/2017
Post-partum depression screening by pediatric providers billing update, April 10, 2017
4/10/2017
Nine medical policies updated, April 25, 2017
4/25/2017
CMEs/best practices for patient centered quality care, May 3, 2017
5/3/2017
Four clinical policies updated, October 26, 2016
10/26/2016
Pharmacy benefit updates, May 5, 2017
5/5/2017
Five clinical policies updated, May 26, 2017
5/26/2017
Online provider portal and IVR notice, June 20, 2017
6/20/2017
Four clinical policies updated, June 26, 2017
6/26/2017
Non-priced codes reimbursement policy Network Notification and other reimbursement policy updates, July 1, 2017
7/1/2017
Pharmacy benefit updates, July 7, 2017
7/7/2017
Infertility services medical policy, July 25, 2017
7/25/2017
MassHealth Automated Voice Response system, August 21, 2017
8/21/2017
Network Notification #168 Community Health Center/Federally Qualified Health Center Billing, August 21, 2017
8/21/2017
Title Date
M-176 Billing Requirements for Clinical Trials, May 1, 2019
4/26/2019
M-177 New Non-Medicare Certified Home Health Agency Reimbursement Policy, May 1, 2019
4/27/2019
M-180 Change to Medicaid National Correct Coding Initiative Edits
7/30/2019
M-106 Orally Administered Enteral Units of Measure, May 18, 2009
5/18/2009
M-107 Birthing Class Billing Instructions, May 18, 2009
5/18/2009
M-108 CORRECTION Orally Administered Enteral Units of Measure, June 15, 2009
6/15/2009
M-109 Billing paravertebral facet joint and transforaminal procedures, June 29, 2009
6/29/2009
M-110 New mailing process - Network Notifications, Clinical Coverage Criteria Policy Updates, July 31, 2009
7/31/2009
M-111 Mid-Level Clinician Reimbursement Reminder, August 25, 2009
8/25/2009
M-112 WIC Coverage of Enteral Products, August 25, 2009
8/25/2009
M-113 New CBHI Benefits Effective 10/1/2009: In-Home Behavioral Services and Therapeutic Mentoring, August 28, 2009
8/28/2009
M-114 H1N1 and Seasonal Flu Vaccine, and Administration, October 30, 2009
10/30/2009
M-115 New provider forms: Rehab Smart Sheet; Coordination of Benefits Indicators; Credit Balance Refund Data, October 30, 2009
10/30/2009
M-116 Corneal Tissue Transplant Materials and Ocular Prosthetics, November 11, 2009
11/11/2009
M-117 New/Revised Reimbursement Policies, November 11, 2009
11/11/2009
M-118 New right fax numbers for prior authorizations, November 24, 2009
11/24/2009
M-119 Reimbursement changes, November 30, 2009
11/30/2009
M-120 New 2010 CPT and HCPCS Crosswalks, December 21, 2009
12/21/2009
M-121 Expansion of radiology management program for non-emergent, outpatient studies, January 8, 2010
1/8/2010
M-122 Billing and authorization changes related to Beacon Health Strategies behavioral health management, November 23, 2010
11/23/2010
M-123 Commonwealth Care Hearing Aid Benefit Elimination, May 25, 2010
5/25/2010
M-124 Chiropractic care is not covered for MassHealth Essential members/ Chiropractic code set, December 1, 2010
12/1/2010
M-125 Prior authorizations for specialty care from BMC HealthNet Plan-contracted providers, December 23, 2010
12/23/2010
M-126 Acute Hospital Limit, February 1, 2011
2/1/2011
M-127 Clarification of New Vaccine Administration Coding, March 31, 2011
3/31/2011
M-128 CPT consultation codes, May 27, 2011
5/27/2011
M-129 Pharmacy copayment changes for MassHealth members, August 15, 2011
8/15/2011
M-130 Changes to Provider Manual, November 1, 2011
11/1/2011
M-131 Billing Change - New National Drug Code Billing Requirements, March 7, 2012
3/7/2012
M-132 Women's Preventive Health Care Services, May 30, 2012
5/30/2012
M-133 Universal Provider Request for Claim Review Form, May 30, 2012
5/30/2012
M-135 Billing Change - New National Drug Code Billing Requirements Update to Plan Network Notification #131, November 2, 2012
11/2/2012
M-136 Billing Change - New National Drug Code Billing Requirements Update to Plan Network Notification #131 and #135, December 31, 2012
12/31/2012
M-137 Hearing Aid Coverage for Children - Commercial Plan members, January 24, 2013
1/24/2013
M-138 Vaccine Administration with Evaluation and Management Service Codes; Visual Acuity Clarification, May 15, 2013
5/15/2013
M-139 Prior Authorization Requirements for Certain Facial Procedures, May 22, 2013
5/22/2013
M-140 Billing Change - Chronic Maintenance Dialysis Performed in Freestanding Dialysis Clinics, July 12, 2013
7/1/2013
M-141 New pharmacy benefits administrator, July 29, 2013
7/29/2013
M-142 Prior Authorization Requirements for Sleep Studies, August 30, 2013
8/30/2013
M-143 Changes resulting from the Affordable Care Act, November 1, 2013
11/1/2013
M-144 Affordable Care Act Section 1202 Primary Care Enhanced Rates, November 7, 2013
11/7/2013
M-145 Reimbursement Policy Change - Multiple Procedure Reduction, November 18, 2013
11/18/2013
M-146 New CMS 1500 Claim Form, March 1, 2014
3/1/2014
M-147 Paper Electronic Remittance Advices, April 15, 2014
4/15/2014
M-148 Drug Screening/Testing: Drugs of Abuse and/or Controlled Substances, June 5, 2014
6/5/2014
M-149 Mother and Newborn Billing Guideline Changes for Qualified Health Plan Members, July 21, 2014
7/21/2014
M-150 Remit Update - APR-DRG, October 1, 2014
10/1/2014
M-151 Modifier Update: Same Day Distinct Procedural Services Reporting with New XE, XP, XS, XU Modifiers, November 21, 2014
11/21/2014
M-152 Changes to Provider Manual: Sections 1.2, 2.1, 4.3, 5.3, 6.13, 9.3, 9.7, 10.5, 14.5, November 1, 2014
11/1/2014
M-153 MassHealth Benefit Change: Acute Inpatient Hospital Coverage Limit Lifted for Members 21 Years of Age and Older, November 18, 2014
11/18/2014
M-154 Rates for Sleep Study Codes and Ultrasound for Abdominal Aortic Aneurysm Screening Code, December 22, 2014
12/22/2014
M-155 Outpatient Services - Coverage of Certain Services in the OUTPATIENT setting only, January 8, 2015
1/8/2015
M-156 New specialty pharmacy, January 30, 2015
1/30/2015
M-157 Prior Authorization Requirements for Drugs Administered in Any Outpatient Setting, April 15, 2015
4/15/2015
M-158 ICD-10 Submission Guidelines, May 29, 2015
5/29/2015
M-159 ICD-10 Prior Authorization Guidelines, June 4, 2015
6/4/2015
M-160 Drug Screening Code Update - ICD-10 Submission Guidelines Clarification, August 1, 2015
8/1/2015
M-161 Automated Test Panel Lab Pricing, November 1, 2015
11/1/2015
M-162 Facility Observation Authorization and Billing Changes, January 1, 2016
1/1/2016
M-163 Billing and Reporting Requirements: Institutional Claims Data Fields, Taxonomy Codes, Home Health, Ambulance Point of Pickup Zip Code and Lifetime Reserve Days, January 1, 2016
1/1/2016
M-164 Hospice billing changes, February 1, 2016
2/1/2016
M-165 Billing Change - National Drug Code Billing Requirements, June 23, 2016
6/23/2016
M-166 Billing Change for Vision Hardware for Qualified Health Plans members, November 1, 2016
11/1/2016
M-167 New Non-Priced Codes Reimbursement Policy, July 1, 2017
7/1/2017
M-168 Community Health Center/Federally Qualified Health Center Billing Update, August 21, 2017
8/21/2017
M-169 New Specialty Pharmacy, November 14, 2017
11/14/2017
M-170 SCO/Medicare Home Health Ineligible Billing Changes, June 1, 2018
6/1/2018
M-171 MassHealth Home Behavioral Health Services, July 1, 2018
7/1/2018
M-172 Medicare Home Health Ineligible Billing Changes, July 1, 2018
7/1/2018
M-173 Correction to Network Notification #171: Home Health Behavioral Health Services, August 1, 2018
8/1/2018
M-174 Billing Instructions for Claims Containing Gender/Procedure Conflict, September 1, 2018
9/1/2018
M-175 New Modifiers Reimbursement Policy, March 8, 2019
3/8/2019
M-178 Sleep Studies Prior Authorization and Billing Changes, June 1, 2019
5/29/2019
M-179 New Benefit for Home Health Aide (HHA) Assisted Daily Living (ADL) Only Services, July 1, 2019
7/1/2019

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