Mass General Brigham ACO
Mass General Brigham Health Plan is proud to provide MassHealth insurance coverage to members of Mass General Brigham Accountable Care Organization.
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Health Related Social Needs (HRSN) Supplemental Services program
Effective January 1, 2025, MassHealth members enrolled in the Mass General Brigham Accountable Care Organization (ACO) may be able to receive additional housing and/or nutrition support through the MassHealth Health Related Social Needs (HRSN) Supplemental Services program. This framework will combine existing Community Support Programs (Community Support for Homeless Individuals (CSP-HI), Community Support Program for Individuals with Justice Involvement (CSP-JI), and Community Support Program Tenancy Preservation Program (CSP-TPP)) and the Flexible Services Program (FSP) into a new Supplemental Services construction.
HRSN Supplemental Services are a standard set of services developed by MassHealth. Each HRSN Supplemental Service has specific programmatic eligibility that a member must meet in order to qualify. For complete HRSN Supplemental Services eligibility, please see the Supplemental Service Manuals found on the HRSN webpage for additional information. View frequently asked questions (FAQs).
MassHealth eligibility redeterminations
On April 1, 2023, MassHealth began eligibility redetermination for all MassHealth members. This process has been on pause since the COVID-19 public health emergency began in March 2020. Below are links to resources created by MassHealth to assist members and providers through this process.
- MassHealth eligibility redeterminations home page
- MassHealth Renewal Help Guide - A guide to helping members with renewals.
- Helping MassHealth members with their renewals - Information for front-line staff about helping with redetermination.
- Flyers, posters, and member-facing materials for MassHealth redeterminations - Materials to help spread the word about redeterminations.
- MassHealthRenew.org - Help for members to renew their coverage.
Watch the training
This training video will walk you through the details of the Mass General Brigham ACO plan and network, including:
- Plan details
- Network information
- Prior Auths and notification guidelines
- Redetermination
- Tools and resources
Frequently asked questions
Mass General Brigham ACO currently partners with MassHealth as the payer. Starting April 1, 2023, Mass General Brigham (the delivery system) will partner with Mass General Brigham Health Plan for ACO patients. Members who have Mass General Brigham Accountable Care Organization (ACO) today will remain with Mass General Brigham Accountable Care Organization (ACO) unless they opt for another plan/provider.
This transition will be effective on April 1, 2023.
Yes, members will receive new ID cards to reflect Mass General Brigham Health Plan contact
information.
Yes, the network will now be the Mass General Brigham Health Plan ACO Network. For a complete list of providers within the Mass General Brigham ACO network please visit our directory.
Yes, your existing commercial contract with Mass General Brigham Health Plan will still be valid. To confirm your participation in the Mass General Brigham Health Plan ACO please reference our provider directory.
You can confirm your participation by utilizing our provider directory by calling 855-444-4647 or by emailing HealthPlanProvidersService@mgb.org.
Yes, primary care services will be provided by Mass General Brigham and Mass General Brigham affiliated PCPs as well as Lawrence Health Solutions and Community Medical Associates who are affiliated with Lawrence General Hospital.
Yes, members will now use the Optum network.
Pharmacy benefits will now be administered through CVS.
Yes, please review the prior authorization requirements/grid here. Authorization requests should be submitted via the Mass General Brigham Health Plan Provider Portal.
Yes, members will continue in care management programs. As we have more information about Community Partners, we will update providers on any potential impacts and create a plan as needed.
Yes, all eligibility can be checked by visiting the Mass General Brigham Health Plan Provider Portal.
Providers can continue to utilize the existing Provider Services line by calling 855-444-4647 or by emailing HealthPlanProvidersService@mgb.org.
No, there is no change for paper claim submission. Providers should refer to the following claims landing page.
The electronic payer ID will remain the same.
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.
When Partners changed to Mass General Brigham the name of the ACO changed from Partners Healthcare Choice ACO to Mass General Brigham ACO. Mass General Brigham ACO currently uses the MassHealth network and providers submit claims to MassHealth (MassHealth is the insurer). As of 4/1 the Mass General Brigham ACO members (formerly Partners Healthcare Choice ACO members) will have their MassHealth coverage through MGBHP and therefore providers need to contract with MGBHP to continue to treat these members.
Have questions?
Don't see what you're looking for? Fill out the form below to get more information or to opt out of the Mass General Brigham ACO network.
This form is only for general questions regarding our Mass General Brigham ACO network. Please do not submit any patient information or PHI via this form. If you have a question about a specific patient, please call our provider service line at 855-444-4647.
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Mass General Brigham Health Plan includes Mass General Brigham Health Plan, Inc.
and Mass General Brigham Health Insurance Company