New in 2024: Complete Access EPO
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About the plan
We are constantly expanding our plan offerings to meet the healthcare needs of our customers and your patients. To support this goal, Mass General Brigham Health Plan introduced our Complete Access Exclusive Provider Organization (EPO) plan in 2024.
If you've received a notice from Mass General Brigham Health Plan indicating that you will be in the Complete Access EPO Plan network, there is no additional action required for you to start seeing members in 2024.
Member ID cards
Frequently asked questions
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What is Complete Access EPO?
Complete Access Exclusive Provider Organization (EPO) is a variation of our Complete HMO plan network.
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Where can members find more information?
Members can find additional information on the Member Portal.
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Can I check eligibility for these members via the provider portal?
Yes, all eligibility can be checked by visiting the Provider Portal.
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How will I be reimbursed for covered services provided to these members?
Reimbursement will be the same as the Complete HMO.
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Will there be a prefix on the ID cards?
There is no dedicated prefix for the Complete Access EPO plan.
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Will my existing contract with Mass General Brigham Health Plan be valid under the new product?
Your existing Commercial contract with Mass General Brigham Health Plan will not change.
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How do I confirm if I am participating in the network?
You can confirm your participation by utilizing our online provider directory or via the Provider Portal
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Will referrals be required for this line of business?
Standard referral rules apply. You can check referral requirements here.
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Are there any changes to the authorization rules for this line of business?
Authorizations will be required where applicable. For the most up-to-date information, visit our prior authorization guidelines page.
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Do I need a new Authorization for a scheduled procedure if one was obtained prior to the member moving to this plan?
No, if a member is moving from one Commercial plan to the Complete Access EPO Plan any authorization that was previously obtained should be valid.
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Will there be any changes to the claims mailing address?
There is no change for paper claim submission. Providers should refer to the information on our claims page.
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Will the electronic payer ID be the same?
The electronic payer ID will remain the same.
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Will there be a change to the time frame for claim submission for this product?
We plan to adhere to the current standard filing rules, which is 90 days unless otherwise specified in your contract. Providers should refer to their contracts for any questions.
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Will there be a different Explanation of Payments (EOP)?
No, we’ll have one combined EOP for all lines of business.
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Where should I direct questions regarding the network?
We're here to help! Please send any additional questions to: CompleteAccessEPOContractingMailbox@mgb.org
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Where can I get more information about the network?
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