MassHealth is a state-funded program and, as such, is subject to annual budget decisions. The Massachusetts state budget runs on a fiscal-year cycle that begins on July 1 and ends June 30 of the following year. MassHealth adult dental benefits have been a frequent target over the past years, with significant benefit reductions that have created havoc for patients and providers. While adult restorative dental benefits were reinstated in 2014, the Massachusetts Dental Society (MDS) will continue to advocate to legislators for full reinstatement of all adult dental benefits.
Become a MassHealth Provider
Effort to Restore Benefits
MassHealth Licensing Requirement for Dentists
New MassHealth Dental Provider Web Portal
On January 1, 2017, MassHealth and the Health Safety Net (HSN) implemented a new provider web portal, upgraded the eligibility system, and made changes to the weekly remittance advice. As with any new system, there have been a few unanticipated technical issues, as well as additional changes. If you have had any difficulties with the provider web portal, please read the update that has been sent out to outline how issues are being resolved and answer frequently asked questions.
Non-Billing Provider/Licensing Requirement Q&A
Patient Load Q&A
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 serve my existing patients only?
Yes, you can just serve your existing patients.
Do I have to be listed in the MassHealth 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 the 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.
FEE SCHEDULE QUESTIONS
Is there a separate fee schedule for children?
Yes, there are two fee schedules: child and adult. The child schedule is Early Periodic Screening, Diagnosis, and Treatment ( EPSDT) rate. The adult schedule is listed as Allowed Fee. Both schedules are available on the MDS website. The child reimbursement rates are more favorable than the adult. EPSDT 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 Online Service Center.
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 be enrolled in MassHealth?
It takes approximately three months to process an application.