№ lp_1_2_32577
File format: docx
Character count: 10559
File size: 190 KB
This document provides updates on MassHealth managed care entities, detailing pharmacy billing, coverage updates, eligibility verification, and changes related to 340B pharmacy claims.
Year:
2024
Region / City:
Massachusetts
Theme:
Pharmacy billing and coverage for MassHealth members
Document Type:
Provider Bulletin
Organ / Institution:
MassHealth
Author:
Not specified
Target Audience:
Pharmacies, healthcare providers
Period of validity:
Effective January 1, 2025
Approval Date:
December 16, 2024
Date of changes:
January 1, 2025
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.
The file will be delivered to the email address provided at checkout within 12 hours.
Don’t have cryptocurrency yet?
You can still complete your purchase in a few minutes:- Buy Crypto in a trusted app (Coinbase, Kraken, Cash App or any similar service).
- In the app, tap Send.
- Select network, paste our wallet address.
- Send the exact amount shown above.
The final amount may vary slightly depending on the payment method.
The file will be sent to the email address provided at checkout within 24 hours.
The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Region / City:
Massachusetts
Subject:
Health Insurance, Medicaid, and CHIP
Document Type:
Implementation Guide
Organization / Institution:
MassHealth
Author:
MassHealth
Target Audience:
Healthcare providers, trading partners, and Managed Care Entities
Effective Period:
From January 1, 2012
Approval Date:
August 2025
Date of Changes:
Future updates will be included in subsequent versions
Context:
Implementation guide for electronic healthcare transactions, specifically for Medicaid and CHIP encounter data reporting under the HIPAA standards for MassHealth Managed Care Entities.
Year:
2025
Region / City:
Massachusetts
Subject:
Healthcare, Medicaid, Claims Reporting
Document Type:
Companion Guide
Organization:
MassHealth
Author:
MassHealth
Target Audience:
Healthcare providers, Trading Partners, Managed Care Entities (MCEs)
Effective Period:
From August 2025
Approval Date:
August 2025
Revision Date:
Not specified
This document is a companion guide for the ASC X12N 005010X299A1 Post-Adjudicated Claims Data Reporting:
Institutional standard, aimed at assisting MassHealth Managed Care Entities in reporting claims electronically in compliance with HIPAA.
Year:
2023
Region / City:
Massachusetts
Topic:
Disability Benefits Application
Document Type:
Application Instructions
Agency:
Executive Office of Health and Human Services
Author:
Commonwealth of Massachusetts
Target Audience:
Individuals applying for MassHealth due to disability
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2025
Jurisdiction:
Commonwealth of Massachusetts
Region:
Massachusetts
Document type:
Evaluation report
Program:
MassHealth
Policy area:
Medicaid managed care quality
Issuing body:
Executive Office of Health and Human Services, Office of Medicaid
Publication date:
February 2025
Evaluation period:
Calendar Years 2022–2024
Measurement years covered:
2020–2022
Regulatory framework:
42 CFR §438.340(c)(2)
Related strategy:
MassHealth Comprehensive Quality Strategy (published June 2022)
Care programs covered:
ACO Program, MCO Program, PCC Plan, One Care, Senior Care Options
Quality domains:
Care quality, equity, value-based care, person- and family-centered care, care coordination
Source type:
Government administrative evaluation
Year:
2023
Region / City:
Massachusetts
Theme:
Health Care, Medicaid
Document Type:
Companion Guide
Organization / Institution:
MassHealth
Author:
Not specified
Target Audience:
Technical and operational staff
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2026
Region / City:
Massachusetts, USA
Document Type:
Application Form
Issuing Authority:
Commonwealth of Massachusetts, Executive Office of Health and Human Services (EOHHS)
Target Audience:
Individuals applying for long-term care benefits
Required Documentation:
Proof of income, assets, and insurance
Sections:
Member Information, Income, Assets, Spouse/Dependent Information, Health Insurance, Signature
Year:
2023
Region / City:
Massachusetts
Topic:
Health Care, Medicaid, Electronic Transactions
Document Type:
Companion Guide
Organization:
MassHealth
Author:
Not specified
Target Audience:
Technical and operational staff responsible for electronic health-care transactions
Period of Validity:
Ongoing
Approval Date:
November 2023
Date of Changes:
Not specified
Program:
MassHealth
Related program:
Health Safety Net
Note:
Related program
Supplemental Nutrition Assistance Program
Document type:
Renewal application form
Issuing authority:
Massachusetts Executive Office of Health and Human Services
Target population:
Seniors living in the community
Geographic scope:
Massachusetts
Application purpose:
Determination of continued eligibility for health coverage
Application sections:
Household information, income, assets, other health insurance, certification and signature
Submission methods:
Mail, fax, hand delivery, online submission
Income types covered:
Employment income, Social Security, pensions, rental income, veterans benefits
Assets covered:
Bank accounts, life insurance, securities, annuities, trusts, real estate, vehicles
Legal basis:
Certification under pains and penalties of perjury
Administrative use restriction:
For MassHealth use only
Year:
2023
Region / City:
Massachusetts
Subject:
Health insurance, data sharing
Document type:
Form
Organization / Institution:
MassHealth
Author:
MassHealth
Target audience:
MassHealth applicants, legal representatives
Validity period:
12 months
Approval date:
N/A
Date of amendments:
N/A
Year:
2021
Region / City:
Massachusetts
Topic:
Medicaid, Nursing Facilities, Health Care Reporting
Document Type:
Bulletin
Organization:
Executive Office of Health and Human Services, Office of Medicaid
Author:
Amanda Cassel Kraft
Target Audience:
Nursing Facilities Participating in MassHealth
Effective Date:
October 1, 2021
Approval Date:
September 2021
Modification Date:
May 18, 2020
Year:
2021
Region / City:
Massachusetts
Subject:
Adult Foster Care, Primary Care, Medical Necessity
Document Type:
Form
Agency/Organization:
Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid
Author:
Commonwealth of Massachusetts
Target Audience:
AFC providers, Primary Care Providers, MassHealth members
Validity Period:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2020
Region / City:
Massachusetts
Topic:
Telehealth, Adult Day Health Services
Document Type:
Bulletin
Organization / Institution:
Executive Office of Health and Human Services, Office of Medicaid
Author:
Amanda Cassel Kraft, Acting Medicaid Director
Target Audience:
One Care Plans and Senior Care Organizations Participating in MassHealth
Effective Period:
August 1, 2020, through November 30, 2020
Approval Date:
September 2020
Modification Date:
Not specified
Year:
2016
Organization:
MassHealth
Document type:
Questions and Answers
Topic:
Accountable Care Organization (ACO) program
Audience:
Public, potential bidders
Region:
Massachusetts, USA
Date of release:
September 30, 2016
Related period:
FY17–FY21
Year:
2025
Region / City:
Massachusetts
Topic:
Health care, Medicaid, CHIP
Document Type:
Implementation Guide
Organization:
MassHealth
Author:
Unknown
Target Audience:
Health care providers, trading partners
Period of Validity:
Ongoing
Approval Date:
Unknown
Date of Changes:
Unknown
Year:
2023
Region / City:
Massachusetts
Topic:
Transportation Services
Document Type:
Informational Sheet
Organization:
MassHealth
Author:
MassHealth
Target Audience:
MassHealth members
Effective Period:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2021
Region / City:
European Union
Topic:
Cross-border marketing of EU AIFs
Document type:
Notification letter
Author:
European Commission
Target audience:
AIFMs, regulatory bodies, financial institutions
Period of validity:
Not specified
Approval date:
Not specified
Amendment date:
Not specified
Year:
2023
Region / City:
Oregon
Topic:
Health Care, Managed Care Entities, Grievance and Appeal System
Document Type:
Instruction Manual
Agency / Institution:
Oregon Health Authority (OHA)
Author:
Oregon Health Authority (OHA)
Target Audience:
Managed Care Entities, Coordinated Care Organizations, Health Care Administrators
Period of Action:
Quarterly
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Topic:
School Admissions
Document Type:
Application Form
Organization:
West Sussex County Council
Target Audience:
Parents of children seeking school placements
Year:
2025
Jurisdiction:
Wisconsin
Country:
United States
Document type:
Audit reporting requirements and reporting form
Program:
Managed Long-Term Care
Administering authority:
Department of Health Services, Division of Medicaid Services
Form number:
F-02022
Date of issue:
11/2025
Applicable entities:
Managed Care Organizations (MCOs)
Audit performer:
Independent certified public accountant (CPA) firm
Audit scope:
Claims processing for long-term care, acute, and primary services
Minimum sample size:
70 LTC claims; 85 total claims for FCP and PACE programs
Effective policy reference:
Residential services encounter reporting effective 02/01/2021
Coverage systems referenced:
ForwardHealth, DHS data warehouse
Note:
Year
Subject:
Managed Care, Medicaid, Health Insurance
Document Type:
Manual
Organization:
Health Care Authority (HCA), Department of Social and Health Services (DSHS)
Target Audience:
Staff, Health Care Providers