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MassHealthMedicaid · Administrative · Enrollment · MA · Audiology, OB-GYN, Anesthesiology +7 moreHigh impact

All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected

Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 6, 2026

Summary

Effective January 1, 2027, MassHealth will require all ordering, referring, prescribing, attending, supervising, and operating (ORPASO) providers on claims to be enrolled with MassHealth on the date of service (or within 90 days after first date of service for ordered/referred/prescribed services). Claims with unenrolled providers in these roles will be denied. MassHealth is currently sending informational denial messages to prepare providers for this enforcement.

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What to do

by Jan 1, 2027 · 9 steps
01Billing team must audit all claims submission workflows to ensure attending, supervising, and operating providers are enrolled with MassHealth.
02Verify NPI validity for all such providers on claims.
03Update claim scrubbing logic to validate provider enrollment status before submission.
04Billing team should monitor POSC and 835 remittance advice denial messages (codes 1092, 1093, 1094, 1044, 1045, 1048, 1049, 1021, 1029, 1031, 1053) currently appearing on impacted claims to identify unenrolled providers.
05For any unenrolled ORPASO providers identified, follow processes in MassHealth All Provider Bulletin 376.
06Ensure ordering, referring, and prescribing providers (including interns, residents, trainees) comply with Massachusetts state law requirement to enroll as either FFS or ORPASO-only providers.
07Pharmacists eligible to prescribe must enroll as ORPASO-only.
08Contact MassHealth Customer Service at (800) 841-2900 for enrollment questions.
09Consequence: Claims will not be payable if required ORPASO providers are not enrolled on the date of service.

Original notice

All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected
mass.gov · Always check the source before changing claims.
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Related changes

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All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealthHighEffective Jan 1, 2027 · EnrollmentBrowse every MassHealth change in the policy list

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