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?
The Mass General Brigham Advantage plans are Medicare Advantage plans offered by Mass General Brigham Health Plan. We continue to offer patients affordable, accessible care and great benefits while allowing providers to deliver care more flexibly than in traditional Medicare.
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?
- Can I check eligibility for Medicare Advantage members via the provider portal?
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, our Medicare Advantage members can call 855-833-3668 for Customer Service. Our hours are:
October 1 – March 31, 8 AM-8 PM ET, Mon-Sun
April 1 – September 30, 8 AM-8 PM ET, Mon-Fri
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 are the names 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?
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.
You can view the Medicare Advantage prior authorization and notification guidelines here: Medicare Advantage Prior Authorization and Notification Guidelines.
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.
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.
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.
Never miss an update
Be the first to get the latest news, tips, and information when you subscribe to our provider Administrative Newsletter.