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Medical Billing Credentialing Massachusetts

Navigating MassHealth's EOHHS System & Jurisdiction K Medicare Rules

Massachusetts runs Medicaid through MassHealth, administered by the Executive Office of Health and Human Services (EOHHS) — a system with its own contract structure separate from standard state Medicaid enrollment. Medicare, meanwhile, runs through National Government Services (NGS) under Jurisdiction K, which covers all of New England. We track both directly for Boston-area and statewide Massachusetts practices.

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Massachusetts medical billing credentialing services
Why Massachusetts Providers Need Specialized Support

MassHealth's Contract-Based Enrollment Model

Unlike states with a single unified provider portal, MassHealth enrollment often requires signing a specific provider contract type matched to how you'll bill — a standard MassHealth Provider Contract for fee-for-service billing, or a Nonbilling MCE Network-Only Provider Contract if you're only accessed through a managed care entity's network. Getting the wrong contract type is a common source of enrollment delays we catch before submission.

120 days How long a Managed Care Entity can hold your network contract while you complete MassHealth enrollment — after which they're required to terminate it if enrollment isn't finished.

Medicare enrollment runs separately through National Government Services (NGS), the MAC for Jurisdiction K — one of the largest MAC jurisdictions geographically, covering Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. NGS's Local Coverage Determinations reflect this multi-state footprint, and we track updates as they're published specifically for the Massachusetts provider community.

Jurisdiction K NGS administers Medicare Part A and B across seven Northeast states — the widest MAC jurisdiction by state count, meaning LCD updates can originate from any of the seven and still apply to Massachusetts providers.

We manage both tracks in parallel — MassHealth's EOHHS contract process and NGS Medicare enrollment — so Massachusetts practices don't have to coordinate two separate systems on their own.

Massachusetts Payer Coverage

We Bill & Credential With Massachusetts's Full Payer Mix

PayerPlan TypeMassachusetts RoleStatus
MassHealth (EOHHS)State MedicaidContract-based enrollment, FFS or MCE Network-OnlyFull Service
Medicare — National Government ServicesFederal MedicareMAC Jurisdiction K (7-state New England region)Full Service
Mass General Brigham Health PlanMassHealth MCEMajor MassHealth managed care entityFull Service
Senior Whole HealthMassHealth MCEDual-eligible / senior care networkFull Service
Blue Cross Blue Shield of MassachusettsCommercial / MADominant commercial payer statewideFull Service
Common Questions

Medical Billing Credentialing Massachusetts — FAQ

What's the difference between a MassHealth Provider Contract and a Nonbilling MCE Network-Only Contract?
A standard MassHealth Provider Contract is for practices billing MassHealth directly on a fee-for-service basis. A Nonbilling MCE Network-Only Contract applies when you're only accessed through a Managed Care Entity's network — common for ordering, referring, and prescribing providers. Choosing the wrong type is a frequent cause of enrollment delays.
Who is Massachusetts's Medicare Administrative Contractor?
National Government Services (NGS) administers Medicare Part A and B for Jurisdiction K, which spans Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont.
How long can a managed care entity hold my contract while I'm still enrolling with MassHealth?
Under federal law, an MCE may hold a network provider contract for up to 120 days while enrollment with MassHealth is completed. After that period, or immediately if MassHealth notifies the MCE the provider can't be enrolled, the MCE must terminate the network contract.
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