Watch our Medicare Advantage training video
In this training, we'll cover:
- Medicare Advantage plan details
- The Medicare Advantage network
- Helpful resources
- What to expect next
- Medicare Advantage member website
- Prescription drug coverage - Search the Medicare Part D formulary and find medical necessity guidelines for Prior Authorization and Step Therapy.
- Medicare forms and resources - Find helpful resources including our Coverage Determination Request form and Part B medical drugs and medical service drugs requiring Prior Authorization.
Frequently asked questions
What is Mass General Brigham Health Plan Medicare Advantage?
Mass General Brigham Advantage is a new Medicare Advantage plan being offered by Mass General Brigham Health Plan (formerly AllWays Health Partners). Medicare Advantage plans offer patients affordable, accessible care and great benefits while allowing providers to deliver care more flexibly than in traditional Medicare.
Why is this new product being offered?
Medicare Advantage is an important clinical and financial model of care, and one which is becoming increasingly popular across the country. We believe Medicare Advantage will help our providers and members and allow us to stay competitive in a rapidly changing landscape.
What are the important features of this product?
Mass General Brigham Medicare Advantage will:
- Deliver a better patient experience through rich benefit offerings and integrated care delivery
- Deploy a value-based care model that will foster population health innovation
- Contribute to a sustainable source of revenue and investment for primary care
Where can members find more information?
You may have patients enrolled in this plan starting in January 2023 – in the meantime, please refer any patient questions to our website MassGeneralBrighamAdvantage.org.
Can I check eligibility for Medicare Advantage members via the provider portal?
Yes, all eligibility can be checked by visiting the Provider Portal: Provider.MassGeneralBrighamHealthPlan.org.
How will I be reimbursed for covered services provided to Mass General Brigham Health Plan Medicare Advantage members?
Reimbursement will be based on Medicare payment rates.
Is there a separate customer service line for Medicare Advantage members?
Yes, members can call 855-833-3668 starting October 1, 2022, 7 days a week from 8 AM to 8 PM. On January 1, 2023, this number will be available from 8am to 8pm, Monday-Friday.
Providers can continue to utilize the existing Provider Services line by calling 855-444-4647.
Will there be a prefix on the Medicare Advantage ID cards?
No, there will be no prefix. These members will have a 10-digit numeric ID number.
What will the names be of the Medicare Advantage products?
- Mass General Brigham Advantage (PPO)
- Mass General Brigham Advantage Secure (HMO/POS)
- Mass General Brigham Advantage Premier (PPO)
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.
How do I confirm if I am participating in the Medicare Advantage network?
You can confirm your participation by utilizing our online provider directory or by calling 855-444-4647.
You can also visit the Medicare Advantage Provider Directory.
Will referrals be required for the Medicare Advantage line of business?
While other HMO products may require referrals, there are no referrals required for our Medicare Advantage HMO/PPO plans.
Are there any changes to the authorization rules for the Medicare Advantage line of business?
Authorizations will be required where applicable. For the most up-to-date Medicare Advantage information, visit provider.allwayshealthpartners.org/medicare-advantage
View the Medicare Advantage prior authorization and notification guidelines PA Grid Medicare Advantage.
Do I need a new Authorization for a scheduled procedure if one was obtained prior to the member moving to the Medicare Advantage plan?
Yes, if a member is moving from a Commercial plan to the Medicare Advantage Plan any authorization that was previously obtained may require a new authorization.
Will there be any changes to the claims mailing address?
There is no change for paper claim submission. Providers should refer to the following claims landing page: MassGeneralBrighamHealthPlan.org/Providers/Claims
Will the electronic payer ID be the same for Medicare Advantage?
The electronic payer ID will remain the same.
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.
Will there be a different Explanation of Payments (EOP) for Medicare Advantage?
No, we’ll have one combined EOP for all lines of business.
I received a notice from Mass General Brigham Health Plan indicating that I will be in the Medicare Advantage network. What do I need to do next?
We are thrilled to have you included in the Medicare Advantage network. There is no additional action required for you to start seeing Medicare Advantage members in 2023.
Where should I direct questions regarding the Medicare Advantage network?
We're here to help! Please complete the form below and a Mass General Brigham Health Plan representative will follow-up with you.
Where can I get more information about the Medicare Advantage network?
Before this network is available to our members in January 2023, we will provide additional information to our network participants. Please sign-up for our blog and newsletter communications to get the latest information sent right to your inbox.
Get in touch
This form is only for general questions regarding Medicare Advantage plans from Mass General Brigham Health Plan. 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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