MedicaidAdministrativeHigh impact
Managed Care Entity Bulletin 133: Additional Details About the MassHealth Standardized Encounter Data Program (SENDPro) Project
MassHealth·MA·Managed Care
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth is implementing a new Standardized Encounter Data Program (SENDPro) beginning in 2026 that requires managed care entities to submit encounter data using industry-standard EDI X12 837 and NCPDP formats. This change affects all providers in MassHealth managed care networks and requires stricter data validation including complete provider NPIs, taxonomies, admission/discharge times, and standardized code sets.
Action Required
Before 2026: Billing team must ensure all claims include complete provider NPIs for all provider types (billing, attending, referring, rendering), valid provider taxonomies per NUCC standards, accurate PID/SL mapping data (provider name, address, taxonomy, NPI), admission and discharge hours for inpatient claims, and error-free standardized code sets. Update billing system validation rules as MCEs will reject incomplete submissions and exclude them from settlement and rate setting.