MedicaidAdministrativeHigh impact
All Provider Bulletin 417: Continued Access to Care for MassHealth Members Transitioning from Managed Care to Fee-For-Service
MassHealth·MA·Managed Care
We identified it
Jul 21, 2026
Summary
MassHealth members transitioning from managed care plans to fee-for-service (FFS) may continue seeing their current providers if they participate in MassHealth FFS. Prior authorization (PA) and pre-admission screening (PAS) approvals from managed care plans will be transferred to the FFS system, but providers will NOT receive notifications for these approvals. Billing teams must proactively verify PA/PAS status in the MassHealth Provider Online Service Center using the member's MassHealth ID before processing claims.
Action Required
Immediately: Billing team must update workflows to verify prior authorization and pre-admission screening status for all MassHealth members transitioning from managed care to FFS by querying the MassHealth Provider Online Service Center using the member's MassHealth ID. Do NOT rely on receiving PA/PAS notifications from MassHealth for these members—proactively look up approval status before claim submission in the MassHealth portal. Train front desk and billing staff to flag transitions and confirm FFS network participation before scheduling. Failure to verify transferred PA/PAS approvals may result in claim denials or service interruptions.