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.
W9
Provide your tax identification number (TIN) to Mass General Brigham Health Plan.
Mass General Brigham Health Plan adopts, endorses and implements these evidence-based guidelines from national sources, professional organizations, or developed by regional collaborative groups. Guidelines serve as a means of establishing standards among medical and behavioral health providers to improve health outcomes. They are not intended to replace clinical judgment.
ADHD
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Asthma
Asthma Management and Prevention
Asthma Management Guidelines
COPD/Emphysema
COPD Management Guidelines
Depression
Adult Guidelines - Major Depressive Disorder
Children and Adolescent Guidelines - Major Depressive Disorders
Diabetes
American Diabetes Association Guidelines
Heart Failure
Management of Heart Failure
High Blood Pressure
Guideline for the Management of High Blood Pressure in Adults
Management of High Blood Pressure
HIV/AIDS
HIV/AIDS Treatment Information Service Guidelines
Osteoporosis
Guidelines for Postmenopausal Osteoporosis
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
US Preventive Task Force (USPTF) Recommendations
Substance Use Disorder/Alcohol Use Disorder
Guidelines for the Treatment of Opioid Use Disorder
Guidelines on Alcohol Withdrawal Management
Optum Resources for Mental Health/Behavioral Health
Clinical Practice Guidelines
Visit the drug alert page to find a complete list of medication recalls and safety information.
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:
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.
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
Medicaid Member Language Needs and Language Services Report
Unconscious Bias in Medicine
Sponsor: Stanford University School of Medicine
Number of credits: 1 credit
Fee: Free
Learn more
Reflecting on Health Disparities and Moving Towards Anti-Racism in Medicine
Sponsor: MMS
Number of credits: 1 credit
Fee: Free
Learn more
Think Cultural Health
Sponsor: HHS.gov
Number of credits: varies by program
Fee: Free
Learn more