You will keep your current MassHealth ID card (the card with the picture of Massachusetts on it), and youll also receive a member ID card from Steward Health Choice. Click here to view the Covered Services List for MassHealth Standard & MassHealth CommonHealth, MassHealth Family Assistance Coverage, or MassHealth CarePlus Coverage. . MassHealth Provider Online Service Center MassHealth members dont pay monthly fees or deductibles. Steward Health Choice has over 3,000 doctors. Form: MCO Enteral Nutrition Prior Authorization. East Boston Neighborhood Health WellSense Alliance, MassHealth Member Handbook and MassHealth Covered Services List, find doctors and hospitals in our network here, See a doctor who will help coordinate all of your healthcare, See specialists (doctors with extra training in an area of medicine, such as cardiology, dermatology, or pediatrics)*, Have 24/7 access to speak with a nurse about your health questions, Get prescriptions covered at your local pharmacy, Get access to behavioral health (mental health and substance use disorder) services, Get extra help for special conditions such as asthma and diabetes, FREE dental kits, including a toothbrush, toothpaste and floss for members ages 4 and up, Up to $100 back for participating in WW (formerly known as Weight Watchers) and $200 back for membership at a qualifying health club, FREE dental kits, including a toothbrush, toothpaste and floss, Up to $200 back to help pay for qualifying gym memberships, Up to $100 back to help pay for WW (formerly Weight Watchers) each year. Some page levels are currently hidden. BMC HealthNet Plan | Provider Resources Use this button to show and access all levels. Your health always comes first. Included in the MHDL are initiatives that the pharmacy program has putin place to better serve the members course of therapy, such as the Pediatric Behavioral Health Initiative (PBHMI) and the Concomitant OpioidBenzodiazepine Initiative (COBI). Boston, MA 02118 Find a Provider. See below for a list of doctors, hospitals, or pharmacies in your plan network. Integrated Care Management Program. Where can I find more information about what prescription drugs are covered? To view MassHealth covered dental services, please see Subchapter 6 Dental Service Codes of the Dental Manual. But there are some cases when we will cover care from a provider who is not in our plans network: Emergency care and urgently needed care is covered when providers in our network are unavailable. BMC HealthNet Plan offers two types of MassHealth plans. MassHealth is the Medicaid program in Massachusetts that offers coverage at no cost for those that qualify. Search this organization MassHealth provides health benefits and help paying for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts. access community-based services and supports. Limitations, copayments, and restrictions may apply. Thank you for your website feedback! We will cover kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plans service area. For detailed information on out-of-network coverage rules, see your Member Handbook: "How to get care from out-of-network providers" (Chapter 3, Section D4). <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> List: Northwood Providers for Enteral Nutrition Requests. The program manages a robust formulary known as the MassHealth Drug List (MHDL) for its members while maintaining clinical appropriateness and cost savings. Behavioral health support is a part of your health plan. Fee-For-Service (FFS) and MassHealth Provider Network, Primary Care Clinician Plan & Primary Care Accountable Care Organizations, MassHealth Electronic Data Interchange (EDI), MassHealth Coordination of Benefits (COB)/Medicare Crossover, MassHealth Claim Status, Reconciliation, and Additional Claims Resources. 1 Wellness Way Canton, MA 02021-1166 Phone: 888.880.8699 ext. Benefits, formulary, and pharmacy and/or provider networks may change on January 1 of . Enroll in coverage any time of the year if you are applying for dental plans or help paying for health coverage including MassHealth, Children's Medical Security Plan (CMSP), Health Safety Net, or ConnectorCare. Go online at MassHealthChoices.com *fastest way* Mail or fax in the MassHealth Enrollment form Call MassHealth Customer Service (1-800-841-2900 TDD/TTY: 711) When can someone change health plans? Plus, depending on your age, income and health, you may not have to pay anythingor just a small feefor your prescriptions. Examples of unusual circumstances which may lead to out-of-network care include: Your primary care provider must approve the care you receive from an out-of-network provider before you seek that care. MassHealth Info and Other Important Contacts. Across the Commonwealth, BH and LTSS Community Partners bring together community resources, health plans and primary care providers (PCPs)to ensure that eligible members receive the right scope and intensity of care in the community. Resources. Click "Get Assistance" or go to MAhealthconnector.org/Help-Center at any time. The quality of such services must meet professionally recognized standards of care. We encourage you to read and evaluate the privacy and security policies of the site you are entering, which may be different than ours. The Provider Online Service Center gives you the tools to effectively manage your business with MassHealth electronically. The provider's special field of practice or expertise, which is obtained through the provider's credentialing application. If Im happy with my doctor, what do I have to do next? Please review the dental policy for each plan. For assistance, please contact DentaQuest customer service at (800) 2075019 between 8 a.m. and 6 p.m., Monday through Friday. Do you need health coverage? Our standard-network plan for individuals and small groups. Providers can find, information about POPS, including helpful billing, Program, including links to the MassHealth Drug, List, Pharmacy Regulations, Pharmacy Facts, Pub, MassHealth Drug List - Health and Human Services, The MassHealth Fee-for-service program within the Office of Provider and Pharmacy Programs, service rendered. This makes it easier to get care and stay connected with your provider. MassHealth Plan Selection Period: Nov 1 - Jan 23: Health Connector Open Enrollment: Dec 23: Health Connector Payment for January Plans: Jan 23: Provider types managed by OLTSS and links to the provider manuals for each: MassHealths behavioral health program offers its members a diverse set of resources to manage their behavioral health needs. This information is self-reported and verified during the initial . Get to healthy with a little more help. You can find doctors and hospitals in our network here, see our privacy policies, and learn how we make sure you get the right care at the right time with our Utilization Management policy. https://masshealth.ehs.state.ma.us/providerdirectory/, MassHealth Standard & MassHealth CommonHealth. Coverage information for COVID-19 home testing kits is available in ourCOVID RESOURCE SECTION. Search for mental health and substance abuse providers. A Decrease font size. As defined in 130 CMR 410.000: Outpatient Hospital Services, hospital outpatient department may also refer to hospital-licensed health centers and other hospital satellite clinics. An official website of the Commonwealth of Massachusetts, This page, Types of MassHealth Network Providers, is, for the handbook, MassHealth Provider Handbook, MassHealth provides assistance paying for benefits for qualified children, families, seniors, and people, These providers are managed under specific areas of MassHealth that are responsible for program, regulations, operating policies and procedures, monitoring of services, providers access, and financial, list of providers and their corresponding manuals. More Find a Doctor Quality Management Program. Behavioral health services are offered in a variety of settings, such as an inpatient or outpatient hospital, mental health or substance use disorder outpatient clinic, members home, private office, and/or nursing facilities. Be ready to give your name, member ID number, and symptoms. Dental care is one of many, dental program regulations at 130 CMR 420.000 and 450.105 describe the dental benefit, service, There are two categories of care under Mass, Dental services utilizing ADA/CDT codes which. East Boston Neighborhood Health WellSense Alliance, MassHealth Member Handbook and MassHealth Covered Services List, find doctors and hospitals in our network here, Visits with a primary care provider (PCP) for routine care, Visits with specialists (doctors who have extra training in an area of medicine), Behavioral health services, including crisis services, Tobacco cessation and substance use disorder services, Home health services, including skilled nursing if you qualify, Preventive dental care (covered by MassHealth directly - learn more about your coverage and how to find a dentist at, Care Management program for those with asthma, diabetes, cancer, or other special health needs. MassHealth network providers are grouped together by the services that they provide to our members. Patients may be determined eligible only for the HSN or may be determined eligible for MassHealth with HSN as a secondary payer for certain services. Please limit your input to 500 characters. QMB-only providers may bill only for medical services for QMB members and Standard members eligible for QMB benefits, whether or not the associated medical services are specified in 130 CMR 400.000 through 499.000. NFs continue to be subject to MassHealth regulations, including 130 CMR 456.000: Long Term Care Services; Department of Public Health regulations, including 105 CMR 150: . Events and Trainings. Who can I talk to if I have a question about my eligibility? As of January 1, 2017, DentaQuest administers the Health Safety Net Dental program. Together Covered Services List | Tufts Health Plan Steward Community Connection makes it easy to search for local programs and services that help you and your family. This is done through our agreements with contracted providers. For assistance, please contact DentaQuest customer service at (800) 207-5019 between the hours of 8 a.m. to 6 p.m., Monday through Friday. Find a Provider Choosing a health plan New primary care providers and health plans Starting April 1, 2023, MassHealth may have new health plan choices in your area. No, your MassHealth benefits stay the same. Accountable Care Organizations (ACO)We partner closely with key providers throughout the state to offer eight unique plans that provide coordinated care to our members. including eligibility, regulations and specific information for patients and providers, visit the following web pages: Section 6401(b) of the Affordable Care Act (ACA). Dental care is one of many benefits available to children and adults who are eligible for MassHealth, the Health Safety Net, and the Childrens Medical Security Plan. In addition to this commitment, our leadership in health equity, research, and teaching is driving the future of care. Extra Benefit programs are subject to change or discontinuation without prior notice. Yes. Insurance and Financial Information - Dana-Farber Cancer Institute MassHealth members don't pay monthly fees or deductibles. these regulations, NFs are required to create care plans and perform care coordination and discharge planning for all residents. Your BMC HealthNet Plan comes with Member Extras, a 24/7 Nurse Advice Line, and more! QMB-only providers may bill only for medical services for QMB members and Standard members eligible for QMB benefits, whether or not the associated medi, cal services are specified in 130 CMR 400.000, Health Safety Net (HSN) pays only acute care hospitals and community health centers for certain essential health, The Health Safety Net pays for the same set of. Members can change health plans during their annual Plan Selection Period Plan Selection Period and Fixed Enrollment Period Office Provider Language Gender Patient Age Range Phone Number Additional Needs Special Needs Handicap Accessible Uses Sedation Plus, depending on your age, income and health, you may not have to pay anythingor just a small feefor your prescriptions. endobj For Providers - C3 - Community Care Cooperative Help paying monthly premiums may be offered to some individuals depending on their income and family size. PDF MassHealth Health Plan Options for 2023 - Mass Legal Services Do you want to become a WellSense Health Plan member? www.StewardCommunityConnection.org. <>/Metadata 149 0 R/ViewerPreferences 150 0 R>> Patients may be determined eligible only for the, As of January 1, 2017, DentaQuest administers, DentaQuest for processing and pricing. Form: Universal Health Plan/Home Health Prior Authorization. If you need to apply for MassHealth you should apply online since MassHealths walk-in enrollment centers are currently closed. BMC HealthNet Plan offers two types of MassHealth plans. Nondiscrimination (Qualified Health Plan). The Health Safety Net pays for the same set of dental services that are covered by MassHealth Standard, plus certain services currently not covered by MassHealth. MassHealth Plans and Enrollment Guide. An ORP provider can be enrolled with MassHealth as a fully participating provider or as a non-billing provider. ConnectorCare plans are a type of Qualified Health Plan available through the MA Health Connector. PCC Quick Links. Effective immediately, Steward Health Choice coverage includes over-the-counter COVID-19 tests. For detailed information on out-of-network coverage rules, see your Member Handbook: How to get care from out-of-network providers (Chapter 3, Section D4). live with independence and dignity in their, participate in their communities to the fullest, MassHealths behavioral health program offers, its members a diverse set of resources to manage, their behavioral health needs. Share sensitive information only on official, secure websites. In addition, we are devoted to training future generations of health professionals in our wide range of residency and fellowship programs. These services are rendered by the following providers: MassHealth pays for outpatient hospital visits and ancillary services (such as radiographic views, laboratory tests, medical supplies, and drugs) that are medically necessary and appropriately provided, as defined at 130 CMR 450.204: Medical Necessity. Call 1-855-860-4949 to learn more. Additionally, you can reach DentaQuest through the MassHealth Dental Program home page and the MassHealth/HSN Dental Provider Web Portal. MassHealth Nursing Facility Bulletin 179 July 2023 The feedback will only be used for improving the website. Form: Medical Prior Authorization Requests. How can I find a list of MassHealth doctors? You must visit healthcare providers that partner with WellSense (also called in-network providers). MassHealth is a Medicaid plan available to qualifying Massachusetts residents. Massachusetts Behavioral Health Partnership. Not sure which plan type you have? Over 65 and Qualify for MassHealth Standard? By accessing the noted link you will be leaving our website and entering a website hosted by another party. The MassHealth Pharmacy Program provides pharmacy coverage for more than one million members of the Commonwealth for acute and chronic prescription medications as well as certain over-the-counter products and professional services such as vaccines. MassHealth Provider Portals | Mass.gov How to enroll? Use this link - MassHealth Drug List to see updates and sign up for e-mail notifications from MassHealth. You can use the MBHP Provider Directory to see if your behavioral health provider is part of the MassHealth network. A Increase font size. Medical Services/Oral Surgery utilizing CPT/, HCPCS codes which are submitted to the Mass-, MassHealth has contracted with Dental Service of Massachusetts, Inc. (DSM) to manage the MassHealth dental program. The MCO has its own provider network that includes primary care providers, specialists, behavioral health providers, and hospitals. Call our Member Services team at 1-855-860-4949 to find out more about our extra benefits! View instructions for finding a doctor online. FAQ: MassHealth Provider Enrollment - Tufts Health Plan Standard, plus certain services currently not covered by MassHealth. Massachusetts Eye and Ear: Insurance Plans Accepted Updated March 2020 Important information about insurance accepted Always check with your own health insurance provider. Our Tufts Health Together plan provides high-quality MassHealth coverage for individuals and is free or low cost to low-income families enrolled in the state's Medicaid plan. This means all MCE network providers must have two provider contracts in place: (1) a network provider contract with Tufts Health Plan and (2) a provider contract with MassHealth.