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</div> </div> </header> </div></div> <main id="main-content" class="body-container-wrapper home-page"> <div class="container-fluid home-row1"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 row1-row-0-padding dnd-section row1-row-0-background-layers row1-row-0-max-width-section-centering row1-row-0-background-color"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell cell_17199413474633-padding dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_module_17199413474635" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><span id="hs_cos_wrapper_module_17199413474635_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="rich_text"><h4>Reimbursement for out-of-network urgent care centers</h4> <p>From July 3, 2024, to October 1, 2024, Mass General Brigham Health Plan will reimburse out-of-network urgent care centers in Massachusetts. <a href="#reimburse" rel="noopener">Learn more</a>.</p></span></div> </div> </div> </div> </div> </div> </div> <div class="row-fluid-wrapper row-depth-1 row-number-3 row1-row-1-padding row1-row-1-force-full-width-section dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-4 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351001472" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><div class="banner-wrapper" id=""> <section class="hero-landing"> <div class="hero__bg hero-bg-7" style="background-image:url(https://massgeneralbrighamhealthplan.org/hubfs/MGBHP%20Rebrand/Rebrand%20images/iStock-1265620914.jpg); background-position:center center;"></div> <div class="hero__inner"> <h1 class="hero__title"> Provider payment guidelines </h1> <div class="hero__content"> </div> </div> </section> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row2"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351129093" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><span id="hs_cos_wrapper_widget_1670351129093_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="rich_text"><a id="reimburse" data-hs-anchor="true"></a> <h2 style="font-size: 42px;">Reimbursement for out-of-network urgent care centers</h2> <p>Beginning on July 3, 2024, and ending on October 1, 2024, Mass General Brigham Health Plan will reimburse out-of-network urgent care centers in Massachusetts as requested below. This is in support of the <a href="https://www.mass.gov/doc/doi-urgent-care-policy-june-2024">recent directive</a> from the Massachusetts Executive Office of Health and Human Services (EOHHS) and <span style="background-color: #ffffff;"><a href="https://www.mass.gov/doc/managed-care-entity-bulletin-119-access-to-out-of-network-urgent-care-clinics-0/download" rel="noopener" target="_blank">Assistant Secretary </a>for MassHealth. </span>Mass General Brigham Health Plan will reimburse urgent care centers in eastern Massachusetts<span style="font-weight: bold;">*</span> as follows:</p> <ul> <li>For Commercial members receiving services provided in urgent care centers with providers with whom Mass General Brigham Health Plan has a contract, but who do not participate in a member’s health plan, Mass General Brigham Health Plan will provide reimbursement for medically necessary urgent care services at the contracted rate for delivered services. Out-of-network providers are not allowed to balance bill members during this time.<br><br></li> <li>For Commercial members receiving services provided in urgent care centers with providers with whom Mass General Brigham Health Plan does not have any contract, Mass General Brigham Health Plan will reimburse medically necessary urgent care services at a rate equal to 135% percent of the rate paid by Medicare for medically necessary urgent care services. Out-of-network providers are not allowed to balance bill members during this time. <br><br></li> <li>The MassHealth Program will reimburse at 100 percent of Medicaid.</li> </ul> <p>Non-contracted providers in Massachusetts should submit claims directly to Mass General Brigham Health Plan (<strong>Payer ID: 04293</strong>). Please review our <a href="https://massgeneralbrighamhealthplan.org/providers/payment-options">payment options</a> and <a href="https://massgeneralbrighamhealthplan.org/providers/claims">claims resource page</a> before submitting claims using one of the following methods:</p> <ul> <li>Call Provider Service at 855-444-4647</li> <li>Mail paper claims to PO Box #323, Glen Burnie, MD 21060</li> <li>Submit a claim through the Provider Portal at <a href="https://provider.massgeneralbrighamhealthplan.org/">MassGeneralBrighamHealthPlan.org</a></li> <li><span>Submit an electronic EDI claim to Payer ID 04293</span></li> </ul> <p>For questions about reimbursement, please email <a href="mailto:HealthPlanProvRelations@mgb.org">HealthPlanProvRelations@mgb.org</a><strong> </strong>or visit the Provider Portal at <a href="https://provider.massgeneralbrighamhealthplan.org/">Provider.MassGeneralBrighamHealthPlan.org</a>.</p> <p style="font-weight: bold;">*Commercial is limited to these counties: Essex, Middlesex, Suffolk, Norfolk, Bristol, Plymouth, Barnstable, Dukes, and Nantucket</p> <p style="font-weight: bold;"> </p></span></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row3"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351149487" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-header" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"> <span id="hs_cos_wrapper_widget_1670351149487_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_header" style="" data-hs-cos-general-type="widget" data-hs-cos-type="header"><h2>Policy payment guideline listing</h2></span></div> </div> </div> </div> <div class="row-fluid-wrapper row-depth-1 row-number-3 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351154979" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><div class="accordion widget_1670351154979" id=""> <ul> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> A - E </a> <div class="accordion-content"> <div class="accordion-item__body"> <p><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/AcupunctureServices.pdf" rel="noopener noreferrer" target="_blank">Acupuncture Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/AllergyTestingandAllergyImmunotherapy.pdf" rel="noopener noreferrer" target="_blank">Allergy Testing and Allergy Immunotherapy</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Ambulance.pdf" rel="noopener noreferrer" target="_blank">Ambulance</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/AmbulatorySurgicalCenters.pdf" rel="noopener noreferrer" target="_blank">Ambulatory Surgical Centers</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Anesthesia.pdf" rel="noopener noreferrer" target="_blank">Anesthesia</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/BariatricSurgery.pdf" rel="noopener noreferrer" target="_blank">Bariatric Surgery</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ChiropracticServices.PDF" rel="noopener noreferrer" target="_blank">Chiropractic Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ClinicalTrials.pdf" rel="noopener" target="_blank">Clinical Trials</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/CommunityHealthCenters.pdf" rel="noopener noreferrer" target="_blank">Community Health Centers</a><br><span style="color: #0066cc;"><a href="http://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Covid-19PaymentPolicy.pdf" target="_blank" rel="noopener noreferrer">Covid-19 Payment Policy – RETIRED 05/11/2023</a><br><a href="https://resources.allwayshealthpartners.org/Provider/PPG/CrisisInterventionEDBoarding.pdf?_ga=2.12876151.1394939143.1670254898-1748427993.1669220054" target="_blank" rel="noopener noreferrer">Crisis Intervention – ED Boarding </a></span><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Dermatology.pdf" rel="noopener noreferrer" target="_blank">Dermatology</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Dialysis.pdf" rel="noopener" target="_blank">Dialysis</a><br><a href="http://resources.massgeneralbrighamhealthplan.org/Provider/PPG/DurableMedicalEquipment.pdf" rel="noopener noreferrer" target="_blank">Durable Medical Equipment</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/EarlyIntensiveBehavioralInterventionServices.pdf" rel="noopener">Early Intensive Behavioral Intervention Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/EnteralFormulaeParenteralNutritionalSolutions.pdf" rel="noopener noreferrer" target="_blank">Enteral Formulae Parenteral Nutritional Solutions</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/EvaluationandManagementServices.pdf" rel="noopener noreferrer" target="_blank">Evaluation and Management Services</a></p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> F- M </a> <div class="accordion-content"> <div class="accordion-item__body"> <p><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/FeeScheduleUpdatePolicy.pdf" target="_blank" rel="noopener noreferrer">Fee Schedule Update Policy</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/GeneralCodingandBilling.pdf" target="_blank" rel="noopener noreferrer">General Coding and Billing</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/HearingAids.pdf" target="_blank" rel="noopener noreferrer">Hearing Aids</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/HomeHealthCareAgency.pdf" target="_blank" rel="noopener noreferrer">Home Health Care Agency</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/HomeInfusion.pdf" rel="noopener">Home Infusion Therapy</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/AcuteHospitalCareatHome.pdf" target="_blank" rel="noopener noreferrer">Hospital at Home</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Hospice.pdf" target="_blank" rel="noopener noreferrer">Hospice</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ImagingServices.pdf" target="_blank" rel="noopener noreferrer">Imaging Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/InpatientHospitalAdmissions.pdf" target="_blank" rel="noopener noreferrer">Inpatient Hospital Admissions</a><br><a href="http://resources.massgeneralbrighamhealthplan.org/Provider/PPG/InpatientRehabilitationandLong-TermAcuteCare(LTAC).pdf" target="_blank" rel="noopener noreferrer">Inpatient Rehabilitation and Long-term Acute Care (LTAC)</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/LaboratoryAndPathology.pdf" target="_blank" rel="noopener noreferrer">Laboratory and Pathology</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/LateChargeBilling.pdf" target="_blank" rel="noopener noreferrer">Late Charge Billing</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/MaximumUnits.pdf" target="_blank" rel="noopener noreferrer">Maximum Units</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/MedicalNutritionalCounselingandDiabetes.pdf" target="_blank" rel="noopener noreferrer">Medical Nutritional Counseling and Diabetes</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/MidLevelPractitioners.pdf" target="_blank" rel="noopener noreferrer">Mid-Level Practitioners</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Modifiers.pdf" target="_blank" rel="noopener noreferrer">Modifiers</a></p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> N - Z </a> <div class="accordion-content"> <div class="accordion-item__body"> <p><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/NailDebridement.pdf" rel="noopener noreferrer" target="_blank">Nail Debridement</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/NewbornCareInpatient.pdf" rel="noopener noreferrer" target="_blank">Newborn Care (Inpatient)</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ObservationServices.pdf" rel="noopener noreferrer" target="_blank">Observation</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ObstetricalServices.pdf" rel="noopener noreferrer" target="_blank">Obstetrical Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/OralMaxillofacialSurgery.pdf" rel="noopener noreferrer" target="_blank">Oral Maxillofacial Surgery</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/OutofNetworkProviderServices.pdf" rel="noopener noreferrer" target="_blank">Out of Network Provider Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/OutpatientClinicServicesFacility.pdf" rel="noopener noreferrer" target="_blank">Outpatient Clinic Services - Facility</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/PTOTST.pdf" rel="noopener noreferrer" target="_blank">Outpatient Physical, Occupational & Speech Therapy</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/PhysicianAdministeredMedications.pdf" rel="noopener noreferrer" target="_blank">Physician Administered Medication</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/PreventiveServices.pdf" target="_blank" rel="noopener noreferrer">Preventive Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ProviderAuditPolicy.pdf" rel="noopener noreferrer" target="_blank">Provider Audit Policy</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/ProviderPaymentDisputes.pdf" rel="noopener" target="_blank">Provider Payment Disputes </a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/RetailClinic.pdf" rel="noopener noreferrer" target="_blank">Retail Clinic</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/RoboticAssistedSurgery.pdf" rel="noopener noreferrer" target="_blank">Robotic Assisted Surgery</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/RoutineFootCare.pdf" rel="noopener noreferrer" target="_blank">Routine Foot Care</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/SeriousReportableEvents.pdf" rel="noopener noreferrer" target="_blank">Serious Reportable Events & Provider Preventable Conditions</a><br><a href="http://resources.massgeneralbrighamhealthplan.org/Provider/PPG/SkilledNursingFacilities.pdf" target="_blank" rel="noopener noreferrer">Skilled Nursing Facilities</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/SleepStudiesAndTherapyManagement.pdf" rel="noopener noreferrer" target="_blank">Sleep Studies and Therapy Management</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/SpineSurgery.pdf" rel="noopener noreferrer" target="_blank">Spine Surgery</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/StandardBloodProductsandServices.pdf" rel="noopener noreferrer" target="_blank">Standard Blood Products and Services</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Telemedicine.pdf" rel="noopener noreferrer" target="_blank">Telemedicine</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/Transplant.pdf" rel="noopener" target="_blank">Transplant</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/UrineDrugTesting.pdf" rel="noopener noreferrer" target="_blank">Urine Drug Testing</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/VaccinesImmunizations.pdf" rel="noopener noreferrer" target="_blank">Vaccines and Immunizations</a><br><a href="https://resources.massgeneralbrighamhealthplan.org/Provider/PPG/VisionServices.pdf" rel="noopener noreferrer" target="_blank">Vision Services</a></p> </div> </div> </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row4"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div 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