MassHealth Non-Billing Provider Regulation:
All physicians who hold an active medical license in Massachusetts must enroll in Mass Health either as billing or non-billing providers – in order to maintain their licensure.
This does not mean that you must accept Mass Health patients.
This is a requirement due to issues processing claims with ordering physicians. Non-billing providers’ NPI may be included as relevant on claims submitted by a billing provider.
Click on the link below to obtain the MassHealth Non-billing Provider Contract for Individuals in order to enroll as a non-billing provider.
This form should be completed and mailed certified to:
MassHealth Customer Service Center
Attn: Provider Enrollment and Credentialing
P.O. Box 121205
Boston, MA 02112-1205
Provider Types Authorized to Order, Refer, or Prescribe
The following types of providers are the only provider types that may be listed on a claim as the ORP provider and are referred to as authorized ORP providers. Interns, residents, and other trainees in the provider types listed below who are authorized to order, refer, or prescribe services are also considered ORP providers
- Certified Nurse Midwife
- Certified Registered Nurse Anesthetist
- Clinical Nurse Specialist
- Licensed Independent Clinical Social Worker
- Nurse Practitioner
- Pharmacist (if authorized to prescribe)
- Physician Assistant
- Psychiatric Clinical Nurse Specialist
Claims for the services listed above that are ordered, referred, or prescribed by a clinician who is not a provider type listed above must include the NPI of the clinician’s supervising physician (or other authorized ORP provider) on the claim. In that situation, the authorized ORP provider must also be enrolled in MassHealth as a fully participating provider or as a non-billing provider in order for the billing provider’s claim to be payable. Note that pharmacy claims must include the individual NPI of the actual prescribing provider.
Massachusetts state law requires that the types of providers listed above apply for enrollment in MassHealth at least as a non-billing provider in order to obtain and maintain state licensure. This licensure requirement will go into effect once MassHealth implementing regulations are promulgated.
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