Provider Information

BMC HealthNet Plan is an experienced, not-for-profit leader in Medicaid and committed to providing high quality health coverage to underserved populations. It’s easy to find everything you need to work with us. In this section you can:

• Login to view and download provider reports, check member eligibility, and view payments
• Request prior authorizations and submit claims
• Go to pharmacy prior authorization forms
• Search the drug formulary
• View important network notifications

Recent Updates

State requires MassHealth enrollees to submit new applications for coverage.

MassHealth resumed their annual Medicaid renewal process. Over 1 million Massachusetts Medicaid members must submit new applications for health benefits this year. If members fail to apply, they will lose their coverage.

See how your patients may be affected.

• PCPs can get support for patients with behavioral health issues. Click here for information.
• To ensure accuracy when verifying member eligibility, there are some important points you need to remember. Please click here for more information.
• We now accept either our own Medical Prior Authorization Request Form or the new HCAS Standardized Prior Authorization Request Form. Go to forms page.
• Incentives available to eligible healthcare professionals and hospitals. Read more.

Recently Mailed Provider Notices

• Pharmacy benefit updates, July 7, 2017
• Four clinical policies updated, June 26, 2017
• Non-priced codes reimbursement policy Network Notification and other reimbursement policy updates, July 1, 2017
• Online provider portal and IVR notice, June 20, 2017
• Five clinical policies updated, May 26, 2017
• Pharmacy benefit updates, May 5, 2017
• CMEs/best practices for patient centered quality care, May 3, 2017
• Nine medical policies updated, April 25, 2017
• Post-partum depression screening by pediatric providers billing update, April 10, 2017
• Eight medical policies updated, March 28, 2017
• Claims editing software reminder, March 23, 2017
• Primary and specialty care wait times, March 21, 2017
• Provider Manual reminder, March 6, 2017
• Nine medical policies updated, February 25, 2017
• Twelve medical policies updated, January 31, 2017
• 2017 CPT codes, January 20, 2017
• Clinical practice guidelines endorsed, January 10, 2017
• Pharmacy benefit updates, January 1, 2016
• Two medical policies updated, December 21, 2016
• Reimbursement policies updated, December 15, 2016
• Four clinical policies updated, November 21, 2016
• BMC HealthNet Plan administrative offices moving, November 3, 2016
• Network Notification #166 Billing Change for Vision Hardware for Qualified Health Plan Members, November 1, 2016
• Four clinical policies updated, October 26, 2016
• Pharmacy benefit update, October 21, 2016
• Reimbursement policy updates, October 1, 2016
• Clinical practice guidelines endorsed, September 20, 2016
• Pharmacy benefit update, September 15, 2016
• Clinical policy updated, August 26, 2016
• Pharmacy benefit update, August 26, 2016
• Pharmacy benefit update, July 19, 2016
• Five medical policies updated, July 19, 2016
• Drug code billing Network Notification and perinatal depression screening, June 23, 2016
• Five medical policies updated, June 20, 2016
• Pharmacy benefit update, May 6, 2016
• Four medical policies updated, April 25, 2016
• Provider Manual reminder, March 23, 2016
• Six medical policies updated, March 23, 2016
• Regional offices closing, March 15, 2016
• Diabetes standards adopted, March 4, 2016
• HealthTrio Connect provider portal update, March 7, 2016 (Provider Portal Administrators; Non-Portal Administrators)
• Pharmacy benefit update, March 3, 2016
• Senior Care Options, January 8, 2016
• Four medical policies updated, November 23, 2015
• Pharmacy benefit update, November 2, 2015
• Network Notification #161; place of service update; and new reimbursement policy, November 1, 2015
• Four medical policies updated, October 21, 2015
• Pediatric behavioral health medication initiative, October 14, 2015
• Pharmacy benefit update, September 4, 2015
• CAQH ProView System update, September 1, 2015
• Four medical policies updated, July 20, 2015
• Pharmacy benefit update, July 6, 2015
• Notice regarding Network Notification #M-160 Drug Screen Code Update - ICD-10 Guideline Clarification, July 27, 2015
• Notice regarding Precision Testing Laboratories, Inc., July 1, 2015
• NICU reimbursement policy and policies review, June 25, 2015
• Two medical policies updated, June 19, 2015
• ICD-10 prior authorization guidelines Network Notification, June 4, 2015
• ICD-10 claim submission guidelines and postpartum depression billing Network Notification, May 29, 2015
• Five medical policies updated, May 21, 2015
• Medical policies updated; claims editing software updated; reimbursement policies updated, March 25, 2015
• Pediatric Pain Clinic opens, March 9, 2015
• Pharmacy Benefit Update, March 5, 2015

See archived Provider Notices.

If you have any questions, please call your Provider Relations Consultant or email us at provider.info@bmchp.org.