Medical billing services in Massachusetts
Billing, coding, credentialing and A/R follow-up for providers in Massachusetts.
Billing in Massachusetts: what is different
MassHealth uses accountable care organizations for many members.
Key payers and contractors in Massachusetts
- Medicare Part A/B
- National Government Services, Jurisdiction JKPortal: NGSConnex
- Medicare DME
- Noridian, DME MAC Jurisdiction ADME supplier claims only · Portal: Noridian Medicare Portal (NMP)
- Medicaid
- MassHealthPortal: MassHealth Provider Online Service Center (POSC)
- Blue Cross Blue Shield
- Blue Cross Blue Shield of Massachusetts
- Medicare Advantage
- UnitedHealthcare, Humana, Aetna, Wellcare, Blue plans and others, depending on the county
Contractor assignments and plan lists change. We confirm the current setup for your practice during onboarding.
How we work with Massachusetts providers
- Medicaid enrollment with the state, then credentialing with each managed care plan you need
- Medicare enrollment through PECOS and claims with National Government Services through NGSConnex
- Credentialing and contracting with commercial and Blue plans
- Eligibility checks that confirm each patient’s plan and assigned MCO before the visit
- Prior authorization tracking by plan
- Denial, appeal and A/R follow-up under each payer’s filing limits
Medical billing in Massachusetts: common questions
Do you bill MassHealth and its managed care plans?
Yes. We bill MassHealth fee-for-service claims and each Medicaid managed care plan, after confirming the patient’s assigned plan for the date of service.
Who processes Medicare claims in Massachusetts?
Medicare Part A and B claims in Massachusetts are processed by National Government Services (Jurisdiction JK), and we submit and track them through NGSConnex. DME supplier claims go to a different contractor, Noridian (DME MAC Jurisdiction A), through the Noridian Medicare Portal (NMP).
Can you credential new providers in Massachusetts?
Yes. We handle state Medicaid enrollment, Medicare enrollment, CAQH and credentialing with the commercial and managed care plans you need in Massachusetts.
Neighboring states and key payers
Get a free billing audit for your Massachusetts practice
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.