Medical Billing Services in Massachusetts
Billing, coding, credentialing and denial management for Massachusetts practices, with Medicare claims through National Government Services (Jurisdiction JK) and Massachusetts Medicaid handled by people who know the rules.
Medical billing for Massachusetts practices
Massachusetts has one of the lowest uninsured rates in the country, and that shows up in a practice's payer mix. Blue Cross Blue Shield of Massachusetts, Point32Health (Harvard Pilgrim and Tufts Health Plan) and Mass General Brigham Health Plan cover much of the commercial market, MassHealth covers a large share of residents, and National Government Services processes Medicare Part B under Jurisdiction K.
Most MassHealth members are attributed to an accountable care organization, so the plan on the card decides where the claim goes and which referral rules apply. MassHealth's 90-day filing window is also far shorter than most states allow. SFA Solutions works with Massachusetts practices remotely and submits most clean claims within 24 hours, well inside that window.
Massachusetts at a glance
| Medicare contractor | National Government Services, Jurisdiction JK |
|---|---|
| Medicaid timely filing | 90 days from the date of service; when another insurer pays first, 90 days from the primary payer's EOB, with a final deadline of 18 months from the date of service in that case (12 months otherwise) |
| NP practice authority | Full |
| Cities we serve | Boston, Worcester, Springfield, Cambridge, Lowell, Brockton, Quincy, Lynn, New Bedford, Framingham |
What Massachusetts billing involves
These are the programs and rules our team works with for Massachusetts claims.
Medicare
National Government Services · JKMassachusetts Part B claims are processed by National Government Services in Jurisdiction JK. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Massachusetts Medicaid
MassHealth (the combined Medicaid and CHIP program for Massachusetts)
Portal: Provider Online Service Center (POSC) for enrollment, eligibility, claims and remittances, run by the Executive Office of Health and Human Services
Medicaid managed care
Most members are in ACOs: Accountable Care Partnership Plans such as Mass General Brigham Health Plan with Mass General Brigham ACO, several WellSense ACO plans, Tufts Health Together with UMass Memorial Health and Fallon Health with Atrius Health, plus primary care ACOs such as Community Care Cooperative. The Tufts Health Together MCO ended January 1, 2026, and the Primary Care Clinician (PCC) Plan remains an option.
Timely filing
90 days from the date of service; when another insurer pays first, 90 days from the primary payer's EOB, with a final deadline of 18 months from the date of service in that case (12 months otherwise).
Commercial and Medicare Advantage
Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care and Tufts Health Plan (both Point32Health), Mass General Brigham Health Plan, Fallon Health, UnitedHealthcare and Aetna are the major commercial carriers. Tufts Health Plan, Blue Cross Blue Shield of Massachusetts, Humana and Aetna are large in Medicare Advantage.
Prompt pay law
Massachusetts law, including M.G.L. c. 175, s. 108(4)(c) for commercial insurers and matching provisions for Blue Cross and HMOs, requires insurers to pay a claim or explain in writing why it was not paid within 45 days of receipt. Late claims accrue interest of 1.5% per month, up to 18% a year.
Nurse practitioners
Full practiceMassachusetts NPs can prescribe independently after at least two years of supervised prescriptive practice, by signing an attestation with the state. NPs still in that period need prescriptive practice guidelines with a supervising qualified health care professional documented for credentialing, while NPs past it enroll with MassHealth, Medicare and commercial plans under their own NPI.
Credentialing
Providers enroll with MassHealth through the POSC, and each ACO or MCO health plan then credentials you separately, even though members are MassHealth members. MassHealth also requires ordering and referring providers to be enrolled, so an unenrolled referring clinician can cause denials on downstream claims. Blue Cross, Point32Health and most other commercial carriers rely on CAQH ProView, so keep your profile attested every 120 days.
Billing challenges Massachusetts practices face
A 90-day MassHealth filing window
MassHealth must receive initial claims within 90 days of the date of service. Late claims qualify only under specific exceptions and require a 90-day waiver request. Most clean claims are submitted within 24 hours, and we work rejections daily to keep claims well ahead of that point.
ACO attribution and plan changes
A MassHealth member's ACO determines which health plan pays and whether PCP referrals are required. On January 1, 2026, the Tufts Health Together MCO was discontinued and about 30 providers changed programs. We check eligibility and plan assignment before each visit to help keep claims from going to the wrong plan.
Different policies at each commercial plan
Blue Cross, Harvard Pilgrim, Tufts and Mass General Brigham Health Plan each publish their own payment policies on modifiers 25 and 59, telehealth place of service codes and behavioral health billing. A claim that pays at one plan can deny at another. We scrub claims against each payer's current policy before submission.
Our services in Massachusetts
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Massachusetts
Massachusetts medical billing questions
What is the timely filing limit for MassHealth?
MassHealth must receive initial claims within 90 days of the date of service. If another insurer was billed first, you have 90 days from the primary payer's EOB, with a final deadline of 18 months from the date of service. Claims outside those windows need a qualifying exception and a waiver request.
Who is the Medicare contractor for Massachusetts?
National Government Services (NGS) is the A/B Medicare Administrative Contractor for Massachusetts under Jurisdiction K (JK). NGS processes Part B claims and redeterminations, and enrollment changes go through PECOS.
How does MassHealth's ACO model affect billing?
Most MassHealth members belong to an ACO. In Accountable Care Partnership Plans, the plan pays the claim and sets its own authorization rules. In primary care ACOs, MassHealth pays the claim directly. Verifying the member's ACO before each visit tells you where to send the claim.
Can SFA Solutions bill for my Massachusetts practice remotely?
Yes. We work inside your existing EHR or practice management system remotely and handle charge entry, claim submission, denials and A/R follow-up for Massachusetts practices. We can typically begin within 24 hours of receiving system access.
Get a free billing audit for your Massachusetts practice
We will review your recent claims and denials against Massachusetts payer rules and show you what can be recovered.
Nearby states
Primary sources
- MassHealth Billing and Claims: Claims Submission
- All Provider Bulletin 410: Changes to MassHealth ACOs on January 1, 2026
- M.G.L. c. 175, s. 108 (Massachusetts Legislature)
- Mass.gov: Apply for APRN Prescriptive Authority
- CMS: Who Are the MACs
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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