Accessing resources to support your mental health and wellness
When you need mental health support, the last thing you want are obstacles getting in the way. Mental health needs have significantly increased over recent years, but the stigma surrounding mental health issues can still make it hard for those struggling to seek help.
Fear of judgment, financial obstacles, and lack of access to care can leave many people feeling isolated, but help is out there. Whether you’re seeking professional support or self-care strategies, knowing where to find resources is crucial to meeting your mental health needs. To make that easier, we’ve rounded up a few to help make that support more accessible. Read the full article.
Contact
MGBHP Provider Service Team assists our provider community with the following inquiries:
• General questions around provider participation status
• Member benefits
• Claim request for review/appeals
• Authorization requirements/escalations
• Medical drug specialties
• Other inquiries related to MGBHP policies and procedures
Phone: 855-444-4647
Email: HealthPlanProvidersService@mgb.org
MGBHP Provider Relations works in partnership with provider offices to build and maintain positive working relationships and respond to the needs of contracted providers and assist with any training and education. Provider Relations can also assist with escalations.
Email: HealthPlanProvRelations@mgb.org
Provider Portal: Register for the portal to complete the following tasks:
• Benefits and cost sharing
• Claims status
• Member eligibility
• PCP changes
• Authorization submission
• EOP
• And more
Register and access the portal here: Provider.MGBHP.org
In this issue:
- Webinar: Behavioral Health for Medicaid Patients on May 30
- Ancillary professional providers can contact Provider Relations for assistance
- ACO Spotlight: MassHealth prior auth update for proton pump inhibitor
- Primary Care Sub-Capitation Code updates
- Last chance: Register now for the spring regional provider meeting on May 20
- Update to prior authorization requirement for observation stays
- Annual CAHPS survey on its way to Medicare Advantage members
- MassHealth RY24 encounter data deadline is July 31
- Multiple procedure reduction rule in progress, expected completion August 1
- Medical policy updates
- Drug code and code updates
- Formulary updates
Webinar: Behavioral Health for Medicaid Patients on May 30
Join us on Friday, May 30 at noon for a free webinar Behavioral Health for Medicaid Patients. Register now and view the agenda below:
- Welcome and Introduction to Behavioral Health Integration in Primary Care – Nina Jain, MD, MBA
- Maximizing the Use of Community Behavioral Health Centers – Curtis Wittmann, MD
- Behavioral Health Community Partners – Katherine Schiavoni, MD
- MGB's Medicaid Social Worker Program — Emily Marion
- Health Related Social Needs Supplemental Services Referrals — Katinka Canning
Ancillary professional providers can contact Provider Relations for assistance
To assist with current call wait times, ancillary professional providers may email the Provider Relations team at HealthPlanProvRelations@mgb.org as an alternative communications method.
ACO Spotlight: MassHealth prior auth update for proton pump inhibitors
MassHealth updated prior authorization requirements in the MassHealth Drug List (MHDL) for multiple acid-blocking medications (proton pump inhibitors, or PPIs) for pediatric patients. We developed the following guide to clarify which drugs are now available without prior authorization.
Primary Care Sub-Capitation Code updates
MassHealth is making the following changes to the Primary Care Sub-Capitation Code Set:
Following their deletion by the American Medical Association, codes 99441, 99442, and 99443 have been removed from the Code Set and are being replaced by 98008-98016, a set of newly created audio-only visit codes 98000-98007, audio-video visit codes, are also being added to the Code Set.
The new codes have been retroactively added to the code set effective 1/1/25; no further action is required from providers as claims submitted for the new codes on this date or after will be reviewed/reprocessed accordingly. Mass General Brigham Health Plan’s system and Primary Care Sub-Capitation Resource Guide Primary_Care_Sub-Capitation_Resource_Guide.pdf have been updated to reflect these recent codes updates.
Last chance: Register now for the spring regional provider meeting on May 20
We're excited to invite contracted providers to our spring regional provider meeting on Tuesday, May 20, from 9 a.m. to 12 p.m. at our Assembly Row headquarters in Somerville, MA. Please RSVP here by May 9.
Update to prior authorization requirement for observation stays
To support timely access to care and reduce administrative burden, Mass General Brigham Health Plan is removing the prior authorization requirement for observation stays for our Medicaid and Commercial members. Effective 5/1/25, observation stays up to 48 hours (two calendar days) will be covered without prior authorization. Providers should follow standard prior authorization procedures for length of stay’s greater than 48 hours and an inpatient admission is required. Inpatient hospitalization requests require a separate authorization.
This change is designed to streamline the care process while ensuring proper claims processing. Providers should continue to follow standard clinical documentation and billing practices. Thank you for your continued partnership in delivering quality care to our members.
Annual CAHPS survey on its way to Medicare Advantage members
It’s CAHPS season! The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is here! This nationally standardized tool measures patient experiences with healthcare providers and systems including health plans. During this time, patients and health plan members will be surveyed using a multi-modal approach to gather valuable feedback.
We need your partnership to ensure every patient and health plan member receives exceptional care—when they need it, where they need it, and how they need it. Below, we’ve outlined practical, proven tips to help you deliver compassionate care that aligns with key Medicare Star measures.
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Star measure – Name and question assessed in the survey |
Proven tips to deliver expectational patient/ health plan member experience |
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Getting Needed Care (GNC) – A composite measure with two questions. • In the last six months, how often did you get an appointment to see a specialist as soon as you needed? • In the last six months, how often was it easy to get the care, tests, or treatment you needed?
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· Guide patients on where to access necessary tests or lab work. · Ensure Prior Authorizations (PAs) are completed promptly to prevent delays. · Coordinate with specialists to schedule appointments quickly. · Provide patients with specialist contact details before they leave your office. |
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Getting Care Quickly (GCQ) – A composite measure with two questions. • In the last six months, when you needed care right away, how often did you get care as soon as you needed? • In the last six months, how often did you get an appointment for a check-up or routine care as soon as you needed? |
· Reserve time slots for urgent care or walk-in visits. · Offer telehealth appointments for quicker access when possible. · Encourage routine check-ups and follow-ups to address concerns proactively. · Set realistic expectations for in-person visits by explaining timelines and offering alternatives. |
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Care Coordination (CC) – A composite measure with six questions. In the last six months: • When you visited your personal doctor for a scheduled appointment, how often did he or she have your medical records or other information about your care? • When your personal doctor ordered a blood test, x-ray, or other test for you, how often did someone from your personal doctor’s office follow up to give you those results? • When your personal doctor ordered a blood test, x-ray, or other test for you, how often did you get those results as soon as you needed them? • How often did you and your personal doctor talk about all the prescription medicines you were taking? • Did you get the help you needed from your personal doctor’s office to manage your care among these different providers and services? • How often did your personal doctor seem informed and up-to-date about the care you got from specialists? |
· Review the patient’s medical history, prescriptions, and test results before their visit. · Discuss any recent specialist visits or external care received. · Ensure medical record consent is on file for seamless communication between providers. · Encourage patients to use online portals to access test results and updates quickly. |
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Rating of Health Care Quality (RHC) – A single question measure with rating scale. • Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last six months? |
· Conduct internal surveys to identify areas for improvement in patient experience. · Create patient councils to gather feedback and implement suggestions for better care delivery.
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We’re here to help!
Mass General Brigham Health Plan is committed to supporting you during CAHPS season and beyond. If you have questions about the survey or need guidance on enhancing patient experiences, reach out to your Provider Relations Representative.
Thank you for your continual dedication and partnership in delivering outstanding care to our patients and health plan members!
MassHealth RY24 encounter data deadline is July 31
MassHealth has communicated to all plans that 2024 claims must be adjudicated by July 31, 2025. This means all providers must submit claims with a 2024 date of service no later than July 1, 2025, to meet this adjudication deadline. If there are questions or concerns about 2024 claims, please contact Customer Service or your Provider Account Executive. We appreciate your collaboration on these efforts over the coming months.
Multiple procedure reduction rule in progress; expected completion August 1
Mass General Brigham Health Plan’s update to its multiple procedure reduction rule remains in progress and is expected to be completed by
August 1, 2025.
Multiple Procedure Reduction Rule: When multiple surgical procedures are performed in the same operative session, the procedure with the highest RVU will be reimbursed at 100% of the allowed amount and all subsequent, lower RVU-valued procedures, will be reduced per the Plan’s Modifiers Provider Payment Guidelines, unless otherwise specified in the provider’s contract.
Medical policy updates
Thirty-two (32) medical policies were reviewed and passed by the Mass General Brigham Health Plan’s Medical Policy Committee. View a summary of the updates here. These policies are now posted to MGBHP.org.
For more information or to download our medical policies, go to https://www.MGBHP.org/providers/medical-policies and select the policy under the medical policy listings.
Drug code and code updates
View code updates for May 2025 here.
View the coverage summary for new drug codes here.
View the code summary for Medicare Advantage here.
View the code summary for MGB ACO and commercial here.
Formulary updates
View the formulary updates here.