While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members. This includes the following:
- Providers are responsible for checking Electronic Verification System (EVS) through the Provider Online Service Center, and other sources for MassHealth eligibility, to determine whether a patient was insured on the date a service was provided.
- Providers who participate in MassHealth must accept payment from MassHealth as payment in full.
- Providers may not solicit, charge, receive, or accept payment from MassHealth members for any services payable by MassHealth.
- As soon as a provider learns an individual was a MassHealth member at the time a service was provided, the provider must immediately return any sums solicited, charged, received, or accepted from the member and must bill MassHealth.
- Some patients may not appear to be eligible for MassHealth at the time of service but may be retroactively reinstated at a later date. Remember to also check eligibility in EVS prior to billing the member for services or sending a bill to collections.
For more information, please refer to MassHealth’s MassHealth All Provider Bulletin 372.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,