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

• SCO Providers: Medicare members will soon begin receiving new Medicare cards in the mail. The Social Security numbers (SSNs) are scheduled to be removed from all cards by April 2019. Visit CMS.gov for more information.
• MassHealth will sunset its antiquated Automated Voice Response system as of September 1, 2017. Learn more.
• We no longer accept modifications to claims over the phone. If any data element of the claim is incorrect and requires a change for reprocessing and payment, please submit a Corrected Claim by following the documented processes outlined in our Provider Manual.
• 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. Learn more.

Recently Mailed Provider Notices 

• PCPs: Community Partners Program launches, June 19, 2018
• SCO, MassHealth and Qualified Health Plan notices, May 29,2018
• One clinical policy updated, May 21, 2018
• Pharmacy benefit update, May 11, 2018
• Reimbursement and medical policies notice, April 23, 2018
• Message from the Health Connector Regarding New Health Plan Options, April 11, 2018
• Prior-authorization inquiries, March 30, 2018
• Check the status of claims via our HealthTrio provider portal, March 20, 2018
• Benefit year/authorization changes, March 9, 2018
• Pharmacy benefit update, March 1, 2018
• Special Kids Special Care program, March 1, 2018
• Reimbursement and Clinical policies updated, February 26, 2018
• Two clinical policies updated, January 19, 2018
• Accountable Care Organization update, January 18, 2018
• SCO plan is where you are, January 18, 2018
• Pharmacy benefit update, January 9, 2018
• Three clinical policies updated, January 2, 2018
• Pharmacy benefit update, December 18, 2017
• Reimbursement polices updated, December 18, 2017
• Wait times for appointments, December 11, 2017
• Pharmacy benefit update, November 28, 2017
• Five clinical policies updated, November 22, 2017
• Pharmacy benefit update CORRECTED, November 16, 2017
• Medicaid ACO reform training, November 15, 2017
• New specialty pharmacy Network Notification, November 14, 2017
• Annual SCO Model of Care training, November 13, 2017
• Pharmacy benefit update, November 9, 2017
• One SCO reimbursement policy updated, November 2, 2017
• Four clinical policies updated, October 26, 2017
• Five clinical policies updated, September 28, 2017
• Pharmacy benefits update, August 22, 2017
• MassHealth Automated Voice Response system, August 21, 2017
• Network Notification #168 Community Health Center/Federally Qualified Health Center Billing, August 21, 2017
• Infertility services medical policy, July 25, 2017
• 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, 2017
• 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.