Do you handle MassHealth and its ACOs?

Yes. The ACO or MCO a member is enrolled with carries the rules, so it is identified at eligibility and the claim is handled accordingly.

Do you know the regional plans, not just the national carriers?

Yes, and they are configured as separate payers with their own edits and appeal routes rather than as generic commercial payers.

Do you check for underpayments?

Yes, line by line against the expected rate. A claim marked paid is not necessarily a claim paid correctly.

Can we start with a coding audit rather than full billing?

Yes. A retrospective coding and E/M audit is available as fixed-scope work, with written findings and a remediation plan, independent of who does your billing.

Massachusetts

Medical billing for Massachusetts practices

Massachusetts has a distinctive payer market: a strong regional commercial sector rather than a national-carrier monopoly, and a Medicaid program, MassHealth, built substantially around accountable care organizations. Both reward billing that knows the local rules and punish billing that does not.

MassHealth ACOs and referral discipline

ACO-based coverage puts weight on referrals and primary care attribution, and a claim that is clean on coding can still deny for a referral that was never captured. Referral and authorization requirements are checked at eligibility, before the visit, which is where that denial is cheap to prevent and after which it is expensive to appeal.

Regional commercial payers

The dominant plans here are regional rather than national, with their own edits, portals and appeal routes. They are configured as distinct payers with their own rules instead of being treated as generic commercial payers, because their denials are specific and their appeal windows are their own.

Underpayment and reconciliation

Payments are posted line by line and reconciled against expected contracted rates so short payments and silent adjustments surface as variances. In a market with concentrated regional contracts, a small per-claim underpayment repeated across a year is worth more than most denial backlogs.

MassHealth

Most MassHealth members are enrolled with an ACO or MCO, which carries the authorization rules and referral expectations. Which one a patient belongs to determines how the claim must be handled.

Program: MassHealth
Administered by: Massachusetts Executive Office of Health and Human Services
Managed care: MassHealth ACOs and managed care organizations

Payers we work in Massachusetts

Blue Cross Blue Shield of Massachusetts
Harvard Pilgrim Health Care
Tufts Health Plan
UnitedHealthcare
Aetna
MassHealth ACOs and MCOs

Not an exhaustive list, and not a claim of network participation on your behalf — your contracts are yours. It is the payer mix we are set up to work in Massachusetts.

Services available to Massachusetts practices

Billing in Massachusetts — common questions

Do you handle MassHealth and its ACOs?: Yes. The ACO or MCO a member is enrolled with carries the rules, so it is identified at eligibility and the claim is handled accordingly.
Do you know the regional plans, not just the national carriers?: Yes, and they are configured as separate payers with their own edits and appeal routes rather than as generic commercial payers.
Do you check for underpayments?: Yes, line by line against the expected rate. A claim marked paid is not necessarily a claim paid correctly.
Can we start with a coding audit rather than full billing?: Yes. A retrospective coding and E/M audit is available as fixed-scope work, with written findings and a remediation plan, independent of who does your billing.

Everywhere else

All billing services

Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

Book the A/R review See pricing