As of today, March 1, 2018, every MassHealth member will be assigned to a new Accountable Care Organization (ACO), Managed Care Organization (MCO), or Primary Care Clinician (PCC) plan.
You do not need to worry about the specifics of their assignment, but you do need to be sure that you know what their new behavioral health carve-out is.
All MassHealth (MH) members’ behavioral health will be covered by Beacon (Fallon or BMC HeathNet; NHP in Merrimack Valley only), Health New England (in Hampden County only), MBHP, or Tufts Health Public Plans. Please see the list of
Behavioral Plans and phone numbers
We recommend that some time in the next several days you go online to the MassHealth EVS (Eligibility Verification System) to make sure you know what plan the client was assigned to.
If the insurance stayed the same, no change is required. If the insurance changed, and you are currently a provider for the client’s new plan, see the client and bill the new plan.
Make sure you keep track of the authorizations still in place, and request more when needed, as usual. Be sure to read the bulletin that each plan sent to its providers about continuity of care. You can also
read MassHealth’s Continuity of Care document here
. You might want to wait a few days before submitting your bill, to give each system time to get organized and work out any problems.
If you are NOT a provider for the new plan, you can see the client, bill, and be paid for 90 days (certainly for dates of service through May 29; through May 31 for THPP), as long as there is an active authorization from the old plan.
- You must call the new plan and make arrangements to see their member during this transition period. See the phone numbers on this contact sheet.
- For THPP, use the out-of-network authorization form to get approval for transitional visits: https://tuftshealthplan.com/documents/providers/forms/out-of-network-auth-form
- After the transition period, you must have a single case agreement in place, or transfer the client to a therapist who is in network.
- You can apply to become a provider for your client’s new plan (all plans are supposed to be accepting new providers during the transition), IF you have a client who will be covered by that plan.
If the client’s plan has been changed, all current authorizations will be honored by the new plan; however, you must call the new plan to inform them that you will be seeing the member, arrange to be paid by the new plan, and to re-up authorizations that are set to expire.
If the plan to which the member has been assigned is not one they would like to stay with (their PCP is not part of the plan, or the plan covers the wrong region) they will have the opportunity to switch plans until May 31, 2018.
This change does not affect clients with OneCare, or those with Medicare 1º or MassHealth 2º.