Provider inner header

Providers

We're CAQH CORE Certified

We received a CAQH Committee on Operating Rules for Information Exchange (CORE®) health plan certification and are now exchanging electronic administrative data in compliance with the CORE rules.

Learn more about CAQH CORE

Non-participating Providers

If you are a non-participating provider and have received prior approval to provide service to a member, please complete your paperwork to become active in our system.

Complete your paperwork

Claims

To expedite payments, we suggest you submit claims electronically and only submit paper claims when necessary. You can now submit claims through our online portal.

Send Claims within 90 days Qualified Health Plans including ConnectorCare, and within 150 days for MassHealth and Senior Care Options.

In order to pay your claims quickly and accurately, we must receive them within 90/150 days of the date of service. Please submit a:

  • Single claim for each patient.
  • Separate claim form for each provider who saw a patient.
  • Separate claim form for each site where a patient received services.

Submitted Claims Must:

  • Meet all prior authorization requirements and include the prior authorization number.
  • Include both your National Provider Identifier (NPI) and tax ID numbers.

For more information, please see the Provider Manual, Billing and Reimbursement.

For a copy of the CMS-1500 Claim Form, click here.