- Prior authorization forms
- Pharmacy forms
Enrollment and credentialing forms
HCAS provider information form
Update your directory information.
Provider info change form
Enroll or remove providers from your practice. If you're registered for our Provider portal, you can use our convenient online enrollment tool instead.
Provide your tax identification number (TIN) to Mass General Brigham Health Plan.
- Other provider forms
To help you deliver the very best patient care, here are some resources where you can find practice guidelines for chronic or complex conditions.
ADHD Guidelines in Primary Care for Children and Adolescents
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Asthma Management Guidelines
Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Major Depressive Disorder (MDD)
American Diabetes Association Guidelines
HIV/AIDS Treatment Information Service Guidelines
Offering Information on HIV/AIDS Treatment, Prevention, and Research
Perinatal care guidelines
Perinatal Care Guidelines - Massachusetts Health Quality Partners
Preventive care guidelines
Adult Preventive Care Guidelines - Massachusetts Health Quality Partners
Pediatric Preventive Care Guidelines - Massachusetts Health Quality Partners
Other sources of guidelines
Clinical Practice Guidelines
Visit the drug alert page to find a complete list of medication recalls and safety information.
- Information for Aetna Signature, PHCS, non-contracted, and Optum providers
Information for out-of-network providers: the 2021 No Surprises Act
The federal No Surprises Act of 2021 received rulemaking restricts certain out-of-pocket costs to commercial consumers resulting from surprise billing and balance billing. This rule goes in effect for plan, policy, or contract years starting on or after January 1, 2022, for group health plans, health insurance issuers and Federal Employees Health Benefits (FEHB) program carriers and serves to:
- Ban balance billing for emergency services, air ambulance, and certain professional services provided by an out-of-network provider at an in-network facility. Cost sharing for these services must be determined on an in-network basis.
- Requires that patient cost sharing (copayments, co-insurance, or deductibles) for the services outlined above cannot be higher than if such services were provided by an in-network provider. Any cost sharing obligation must be based on median in-network provider rates.
- Prohibits balance billing for qualifying items or services provided by an out-of-network provider at an in-network facility unless a patient provides consent via the process required by CMS. You can reference CMS information here. Providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill the patient more than in-network cost-sharing rates.
The forms and information below are provided in accordance with the federal No Surprises Act of 2021.
Open Negotiation Process
Non-participating providers who render services in an emergency room, an air ambulance, or for certain non-participating providers (for example, an anesthesiologist or radiologist) that provide non-emergency care in a participating facility will receive a Qualified Payment Amount (QPA) when the claim pays the first time.
If a non-participating provider rejects the QPA, they can engage in a 30-business-day open negotiation period with our designee, Clear Health Strategies, to agree on the appropriate rate for applicable items or services. You can find more information from Clear Health Strategies here.
As a reference for the open negotiation process with Clear Health Strategies, you can review the CMS documentation here.
Independent Dispute Resolution
If the Open Negotiation Process fails, either party can elect the Independent Dispute Resolution (IDR) process during the 4-business-day period beginning on the 31st business day after the start of the open negotiation period. You can learn more about initiating the IDR process, view a sample Notice of IDR Initiation, and access the necessary IDR initiation form here.
Both parties must agree on the Independent Dispute Resolution entity. Failure to agree will result in an entity chosen by CMS (Centers for Medicare and Medicaid). Upon selection of the Independent Review entity, both parties will submit offers for payment as well as supporting documentation. The selected Independent Review Entity will issue a binding determination on the payment which will be considered final.
In the case of extenuating circumstances, either party may request an extension of the IDR time period by filling out this form and submitting it to CMS.
HIPAA companion guides
Use these guides to help you test and setup electronic claims-related transactions with Mass General Brigham Health Plan.
270/271 Eligibility Benefit Inquiry & Response
276/277 Claim Status Request & Response
278 Heath Care Services Review – Request for Review and Response
834 Benefit Enrollment and Maintenance
835 Electronic Remittance Advice (ERA)
837 Institutional Billing
837 Professional Billing
Health equity resources
Unconscious Bias in Medicine
Sponsor: Stanford University School of Medicine
Number of credits: 1 credit
Matters: The Benefits of a Diverse Workforce
Number of credits: 1 credit
Reflecting on Health Disparities and Moving Towards Anti-Racism in Medicine
Number of credits: 1 credit
Think Cultural Health
Number of credits: varies by program
- Mass General Brigham ACO Primary Care Sub-Capitation Resource Guide