Patient Load Questions
Can I cap my case load? (limit the amount of MassHealth patients?)
Yes, you now have the ability to cap your case load at any level you see fit. You do not need to
predetermine the amount of patients.
What are the different ways I can cap my case load?
There are different approaches that members utilize to manage their case loads. Some members
choose to only take children, other members select an age range (i.e., 10-18 years of age), while some
members select a zip code to cover. Note: As long as you are not discriminating, you may choose
your own guideline.
Can I just serve my existing patients only?
Yes, you can just serve your existing patients.
Do I have to be listed in the provider directory?
No, you can elect to not have your name listed in the directory. Some members prefer this method so that they are not overwhelmed with phone calls. You need to indicate on your application that you do not want to be listed in directory. Note: you will need to inform your referral network that you are participating in MassHealth if you want them to know that you can now take MassHealth referrals.
Fee Schedule Questions
Is there a separate fee schedule for children?
Yes, there are two fee schedules: children and adults. The children schedule is EPSDT (Early Periodic Screening, Diagnosis, and Treatment) rate. The adult schedule is listed as Allowed Fee. Both schedules are available on the MDS website. The children reimbursement rates are more favorable than the adults. Early and Periodic Screening, Diagnosis, and Treatment Services is described in federal law at 42 U.S.C. §1396d(a)(4)(b) and (r) and 42 CFR 441.50. In Massachusetts, EPSDT-eligible members are in MassHealth Standard or MassHealth CommonHealth categories of assistance, and are under age 21.
How do I know what is covered?
Check the MassHealth Provider Portal
What happens if a MassHealth patient does not show up for his/her appointment? Can I bill them?
You cannot bill a MassHealth patient for a “no-show” even if you have this policy with your private patients.
Can I send a dismissal letter to a patient who does not show for appointments?
Yes, you can send a dismissal letter to a patient who does not show for an appointment providing it is your standard policy to send dismissal letters to ‘no shows.’ You cannot treat MassHealth patients differently than your other patients.
What is the credentialing process?
Instead of a 30-plus-page application requiring Internal Revenue Service documents, W-2s, and other documents, the application has been reduced to 12 pages plus instructions. Not only is the application shorter, it is clearer and easier to complete.
How long is it going to take to get enrolled in MassHealth?
It takes approximately three months to process an application.