Medicare Advantage details for providers

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In this training, we'll cover:

  • Medicare Advantage plan details
  • The Medicare Advantage network
  • Helpful resources
  • What to expect next

Updates

Mass General Brigham Health Plan offers a Medicare Prescription Payment Plan to all members. The Medicare Prescription Payment Plan is a voluntary payment option that works with a member’s current Medicare Part D prescription drug coverage, and it helps members manage their out-of-pocket drug costs by spreading them across monthly payments that may vary throughout the plan year (January – December). This payment option may help members manage their expenses, but it doesn’t save money or lower their drug costs.

If a member selects this payment option, each month they’ll continue to pay their plan premium (if they have one), and they’ll get a bill to pay for their prescription drugs (instead of paying the pharmacy). There’s no cost to for members to participate in the Medicare Prescription Payment Plan and participation is voluntary. Members must voluntarily opt into the Medicare Prescription Payment Plan to participate. To maximize this payment option, members should opt-in to this payment option prior to filling their prescriptions.

For more information about the program, please see the following resources:

Mass General Brigham Health Plan MPPP page

Medicare.gov fact sheet

Medicare.gov MPPP site

Quick links

Frequently asked questions

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.

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

Please refer any patient questions to our website, MassGeneralBrighamAdvantage.org.

Yes, all eligibility can be checked by visiting the Provider Portal: Provider.MassGeneralBrighamHealthPlan.org.

Reimbursement will be based on Medicare payment rates.

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.

No, there will be no prefix. These members will have a 10-digit numeric ID number.

  • Mass General Brigham Advantage (PPO) 
  • Mass General Brigham Advantage Secure (HMO/POS) 
  • Mass General Brigham Advantage Premier (PPO) 

Mass General Brigham Health Plan offers a Medicare Prescription Payment Plan to all members. The Medicare Prescription Payment Plan is a voluntary payment option that works with a member’s current Medicare Part D prescription drug coverage, and it helps members manage their out-of-pocket drug costs by spreading them across monthly payments that may vary throughout the plan year (January – December). This payment option may help members manage their expenses, but it doesn’t save money or lower their drug costs.

If a member selects this payment option, each month they’ll continue to pay their plan premium (if they have one), and they’ll get a bill to pay for their prescription drugs (instead of paying the pharmacy). There’s no cost to for members to participate in the Medicare Prescription Payment Plan and participation is voluntary. Members must voluntarily opt into the Medicare Prescription Payment Plan to participate. To maximize this payment option, members should opt-in to this payment option prior to filling their prescriptions.

For more information about the program, please see the following resources:

Mass General Brigham Health Plan MPPP page

Medicare.gov fact sheet

Medicare.gov MPPP site

Your existing Commercial contract with Mass General Brigham Health Plan will not change.

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.

While other HMO products may require referrals, there are no referrals required for our Medicare Advantage HMO/PPO plans.

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.

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.

There is no change for paper claim submission. Providers should refer to the following claims landing page: MassGeneralBrighamHealthPlan.org/Providers/Claims

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.

No, we’ll have one combined EOP for all lines of business.

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.

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.

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