Please let us know how we can improve this page. The List also specifies the generic over-the-counter drugs that are payable under MassHealth. The MassHealth Pharmacy Online Processing System (POPS) uses diagnosis codes from medical claims for some drug classes when processing claims at pharmacies.
Community Care Cooperative The following tables show the correct combinations, effective for calendar year 2022, for pharmacies for Accountable Care Partnership Plans (ACPPs), Primary Care Affordable Care Organizations (ACOs), Managed Care Organizations (MCO)s, Primary Care Clinician (PCC) Plan, and MassHealth-Only Senior Care Organizations (SCOs). Please limit your input to 500 characters. We appreciate your attention and service to C3 Members during this transition period. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. MassHealth providers need to revalidate their information at least every five years. BIN Show either card to get the services or WebMassHealth has used NCPDP D.0 payer sheet templates as the basis for our payer sheets. Please do not include personal or contact information. All of the benefit, referral, prior authorization, and claims submission rules for the participating health centers and affiliated providers, MassHealth medical or dental providers, and MBHP providers apply to providers serving C3 ACO members. Bring your C3 ID card and your MassHealth ID card with you when you seek medical, behavioral health, or pharmacy services. As part of the required revalidation process, MassHealth must revalidate the enrollment information of all enrolled providers and site, Providers have 45 days from the date of the revalidation letter to complete the revalidation. WebYour C3 ID number is the same as your MassHealth ID. Each employer choses a package for their employees based on price, or types of coverage. NDC Payer Profile Service - MA HEALTH (MA MEDICAID) The State
Call the MassHealth Customer Service Center at 800-841-2900 (TDD/TTY: 711). Your handbook includes important information about C3, your benefits, and our services. C3s Covered Services List describes the MassHealth medical, behavioral health, and pharmacy benefits available to you as a Member of C3. C
This page is located more than 3 levels deep within a topic. Top-requested sites to log in to services provided by the state. This PID/ SL is 10 characters, made up of a 9-digit base number and an alpha service location letter (e.g., 123456789A). Read about dental coverage and rules, please refer to the MassHealth for Dental providers. Please let us know how we can improve this page. If you are eligible for HSN services, hospitals and community health centers will check to determine if they can get reimbursement for services provided to you and your household. Or, you can submit the appropriate Standard Medication Prior Authorization Form: MassHealth; As always, please view our Pharmacy Policies before submitting your coverage review 866-676-9226 (TTY: 711)MondayFriday, 8 a.m. 5:00 p.m. 800-841-2900 or (TTY: 800-497-4648)MondayFriday, 8 a.m. 5 p.m.mass.gov/MassHealth, 75 Federal Street 7th Floor Menu prompt tips. If you are a member, you may have access to doctor visits, dental, prescription drugs, behavioral health endobj
MassHealth limitations, prior authorizations, and referrals apply. Prescribers and pharmacists should review the List and its applicable therapeutic class tables when prescribing a drug or filling a prescription for a MassHealth member. We participate in both MassHealth ACO and Medicare ACO REACH contracts. Just be sure to have a photo ID and your MassHealth ID number with you so your doctor or pharmacy can bill MassHealth for your services. MassHealth You skipped the table of contents section. WebPharmacy prescription processing: Pharmacies should use the following information when filing prescriptions for C3 Members: Member ID: MassHealth ID number. In this issue: MassHealth pharmacy coverage of pediatric enteral special formula and thickening agents; updated MassHealth Brand Name Preferred Over Generic Drug List; BIN/PCN/group numbers for ACOs, MCOs and PCC Plan; and BIN/PCN/group numbers for ACOs, MCOs, PCC Plan, and SCO MassHealth-only. In this issue: MassHealth pharmacy coverage and billing information for COVID-19 oral antivirals. and bureaus. WebCall the MassHealth Customer Service Center to request a new card. If a member has questions about the MassHealth Drug List, please refer the member to MassHealth Customer Service at (800) 841-2900 (TTY: (800) 497-4648 for people who aredeaf, hard of hearing, or speech disabled). The brand names of such combinations are not listed, and therefore require PA. Mass.gov is a registered service mark of the
Everyone in your family who is enrolled in a health plan will get a health plan member ID card. E
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MassHealth ) or https:// means youve safely connected to the official website. Evaluation of a drug includes a thorough review by physicians and pharmacists using medical literature and consulting with specialists, other physicians, or both. Boston, MA 02110, Monday - Friday 8am-5pm (EST) To be eligible for the C3 Medicare ACO REACH, patients must, Beneficiary must be enrolled in Medicare Parts A and B, Beneficiary is not covered under Medicare Advantage or other Medicare managed care plan, Beneficiary must reside in a county that is included in the ACOs service area (counties in which your centers are located and adjacent counties are included in the service area), To verify patient Medicare eligibility, please use one of the Medicare available tools: Medicare Administrative Contractor (MAC) online provider portal, MAC Interactive Voice Response (IVR) system, Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). If you don't have your MassHealth ID number, we'll either need your social security number or your name and date of birth to find you in our system. ) or https:// means youve safely connected to the official website. Thank you for your website feedback! We work to ensure providers are committed to carrying out that vision in their work and patient care. BIN In this issue: Opioid First-Fill Seven-Day Supply Restriction. WebPer 130 CMS 450.223(B), all providers are required to notify MassHealth of any change in any of the information submitted in the application.
Request a MassHealth Card Link to the list of the "Certain MassHealth Outpatient Physician Administered Drugs to be Paid by Fee Schedule" which identifies the current list of Fee Schedule Drugs and reimbursement for outpatient administration of certain physician administered drugs. rx bin number ) or https:// means youve safely connected to the official website. Top-requested sites to log in to services provided by the state. All forms are available atwww.mass.gov/druglist. MassHealth Pharmacy Facts (2016Current) MassHealth Pharmacy Facts (20112015) MassHealth Pharmacy Facts (20042010) Contact Information for Pharmacy Services MassHealth Pharmacy Publications and Notices for Pharmacy Providers MassHealth Pharmacy Publications and Notices for Prescribers and Other Providers. Providers can notify MassHealth and submit a request to update their provider file through the POSC (non-LTSS providers) and though the LTSS Provider The following tables show the correct combinations, effective for calendar year 2023, for pharmacies for Accountable Care Partnership Plans (ACPPs), Primary Care Accountable Care Organizations (ACOs), managed care organizations (MCOs), Primary Care Clinician (PCC) Plan, and MassHealth-only Senior Care Organizations (SCOs). Link to a list of the drugs that are the only nonlegend drugs, with the exception of insulins, that are covered by MassHealth without prior authorization. government organizations, including commissions, departments,
WebPrescription quantities. Dental providers and businesses will be required to complete a recredentialing application utilizing App Central.
In this issue: Reminders for Pharmacy providers about Albuterol Inhalers and updates regarding MassHealth Durable Medical Equipment (DME) Regulation and Deferred Compliance. Providers have 45 days from the date of the revalidation letter to complete the revalidation process. Is group number the same as policy number? Dental providers and businesses will be notified by DentaQuest when it is time to recredential. Call the MassHealth Customer Service Center to request a new card. WebYour (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan and these four numbers are usually found on your Medicare Part D Member ID card and most of you Medicare plan correspondence or printed Is Blue Cross Blue Shield of Massachusetts part of MassHealth? R
If you do not have access to an ePA system you can contact 877-417-1822 for MassHealth members or 877-417-0528 for Qualified Health Plan members. T
The Ombudsman works to make sure you can get your benefits and exercise your rights as an ACO Member. We hope you are participating in one of the provider networks on which C3 Members rely. Providers can notify MassHealth and submit a request to update their provider file through the POSC (non-LTSS providers) and though the LTSS Provider For this reason, MassHealth requests pharmacies to submit all claims through POPS, as some drugs that are designated as requiring PA on theMHDL will process at the pharmacy without a paper PA submitted. of the information submitted in the application. Information about the MassHealth Drug List and updates to the list. MassHealth does not pay for immunizing biologicals (i.e., vaccines) and tubercular (TB) drugs that are available free of charge through local boards of public health or through the Massachusetts Department of Public Health without PA (130 CMR 406.413(C)). WebLink to the current list of APAD Carve-Out Drugs and APEC Carve-Out Drugs for which a Hospital must obtain prior authorization (PA) from MassHealth. For access to the MassHealth EVS system, please contact MassHealth at 800-841-2900 or go to the MassHealth provider service center. If you need assistance, please For help on some common issues, see here..