Brave the cold: What New Englanders can learn from Norway’s winter wellness mindset
When the days grow shorter and the temperatures drop, many New Englanders brace themselves for months of icy roads, gray skies, long, dark nights, and the inevitable winter blues. But in Norway—a country where winter can last half the year—people don’t just endure the cold. They thrive in it. In fact, per the World’s Happiness Report, Norway consistently places in the top 10 and even reached #1 in 2017. So what is their secret? Read more.
Contact
MGBHP Provider Service Team can assist our provider network with inquiries and status requests, including the following:
• General provider self-service tools access questions
• Member benefits and coverage inquiries
• MGBHP policies and procedural questions
• Claim adjudication questions
Phone: 855-444-4647
Email: HealthPlanProvidersService@mgb.org
MGBHP Provider Relations works in partnership with provider offices to build and maintain positive working relationships, respond to the needs of contracted providers, and assist with any training and education. Provider Relations can also assist with escalations.
Email: HealthPlanProvRelations@mgb.org
SCO and One Care Provider Relations works in partnership with contracted SCO and One Care provider offices to foster and sustain collaborative working relationships, address the needs of providers, and support any training and education needs. SCO and One Care Provider Relations can assist with escalations.
Email: HealthPlanSCOandOneCareProvRelations@mgb.org
Provider Portal: Register for the portal to complete the following tasks:
• Benefits and cost sharing
• Claims status
• Member eligibility
• PCP changes
• Authorization submission
• Explanation of Payment (EOP)
• And more
Register and access the portal here: Provider.MGBHP.org
In this issue:
- Reminder about submitting prior authorization requests to Prime Therapeutics via fax
- Explore flu season resources
- Provider FAQs and webinar: Dual Eligible Special Needs Plans (D-SNPs)
- Required model of care (MOC) training for SCO and One Care providers
- SCO and One Care provider manual update: Third-party liability (TPL) claims
- ACO update: Provider appeals limited to Level I effective 4/28/26
- February utilization management updates
- CLAS and health equity training for providers
- ACO spotlight: Health-related social needs (HRSN) program
- Meet the Provider Relations team: Ligia Hartgrove
- Action required: Attest to your provider directory information in the Provider Portal
- Help us improve the member experience — confirm your next available appointments
- Select a designated Provider Portal User Administrator
- Help us keep directory information up to date
- Medical policy updates
- Drug code and code updates
- Medicare pharmacy updates
- Formulary updates
Reminder about submitting prior authorization requests to Prime Therapeutics via fax
To avoid delays in processing prior authorization requests sent via fax to Prime Therapeutics, please be sure to include the provider’s name, NPI, and tax ID number (TIN). Without these three pieces of information, Prime Therapeutics cannot begin the authorization review process, resulting in possible delays in care for our members or a delay in payment to our providers.
As a reminder, providers can also submit requests to Prime Therapeutics via their secure provider portal at www.GatewayPA.com. Providers may also call Prime for urgent authorization requests at 833-895-2611. Hours of operation are 8 a.m.to 8 p.m. for routine requests, and 24 hours per day, seven days a week for urgent requests.
More information about Prime Therapeutics can be found by visiting the Prime Therapeutics Frequently Asked Questions (FAQ) page.
Explore flu season resources
As flu season peaks, it’s important to remind patients about the importance of getting a flu shot and practicing proper infection control. Encourage your care teams to reinforce annual vaccination, hand hygiene, respiratory etiquette, and staying home when sick, especially for high-risk patients such as older adults, pregnant people, and those with chronic conditions. Consider sharing the resources below with staff and patients to help educate them about flu symptoms, when to seek care (including telehealth or urgent care when appropriate), and how to prevent transmission in your practice and the community.
Provider FAQs and webinar: Dual Eligible Special Needs Plans (D-SNPs)
Mass General Brigham Health Plan launched SCO and One Care Dual Eligible Special Needs Plans (D-SNPs) starting January 1, 2026 across eight Massachusetts counties. To support our provider partners, we’ve created a comprehensive Provider FAQ that outlines key features, benefits, enrollment processes, billing guidance, and support contacts.
In addition, please join us for our Dual Eligible Special Needs Plans (D-SNPs) program overview webinar. This session will provide a comprehensive overview of the D-SNPs program, including key updates, eligibility criteria, and how it impacts our provider network. Whether you're new to the program or looking for a refresher, this is a great opportunity to gain valuable insights and ask questions.
Choose the session that works best for your schedule:
|
Date |
Time |
Registration link |
|
Wednesday, February 11, 2026 |
12-1 p.m. ET |
|
|
Wednesday, February 25, 2026 |
12-1 p.m. ET |
Required model of care (MOC) training for SCO and One Care providers
The model of care training for SCO and One Care providers is available and can be completed on our provider resources or Dual Eligible Special Needs Plans (D-SNPs) webpages.
This training is a CMS requirement and must be completed and attested to once per year by all providers contracted with Senior Care Options (SCO) and One Care. If you have any questions, please contact your Provider Relations Representative or email us at: HealthPlanSCOandOneCareProvRelations@mgb.org
Thank you for your continued partnership and commitment to providing high-quality care to our members.
SCO and One Care provider manual update: Third-party liability (TPL) claims
The below update has been added to the SCO and One Care provider manual regarding third-party liability (TPL) claims:
Providers are encouraged to submit a completed TPL Indicator Form to notify EOHHS of the potential existence of other health insurance coverage and to include a copy of the health insurance card with the TPL Indicator Form.
Submit the forms to EOHHS directly:
Email: MassHealthTPL@accenture.com
Fax: 617-357-7604
Mail: MassHealth Third Party Liability Unit, 519 Somerville Avenue #372, Somerville, MA 02143
ACO update: Provider appeals limited to Level I effective 4/28/26
Beginning April 28, 2026, providers will be limited to submitting Level I appeals for denials. Level II appeals will no longer be accepted, and if submitted it will result in a dismissal letter. For additional details, please refer to the Mass General Brigham ACO Provider Manual.
February utilization management updates
- Please ensure that if/when requesting out-of-network services or service providers that the member’s benefit plan includes out-of-network coverage. In the event that out-of-network coverage is dependent upon prior-authorization, please ensure that clinical justification for out-of-network utilization is included in the authorization request.
- As a reminder, peer-to-peer requests are available for commercial fully insured, and self-funded commercial plans. Medicaid ASO, Medicare Advantage and Dual Eligible Special Needs (D-SNP) do not have a peer-to-peer option.
- InterQual Connect continues to be an automated opportunity for providers to request authorizations and receive instant decisions when criteria are met. Please leverage this option through the Provider Portal to facilitate authorization decisions more quickly. Many services are available through this automated approach, increased utilization will streamline the prior authorization process.
- The Utilization Management department is working to ensure the highest quality of care our members. To ensure promotion of appropriate, efficient, and cost-effective use of resources prior-authorization, concurrent review, and post-service retrospective review continue to be methods utilized to facilitate efficient decision-making.
CLAS and health equity training for providers
Visit the provider resources page to access CLAS and health equity trainings focused on delivering culturally and linguistically appropriate services. There is an opportunity to earn credits depending on the program. According to the training offered by the Department of Health and Human Services, “the e-learning program will equip you with the knowledge, skills, and awareness to best serve all patients, regardless of cultural or linguistic background." View the trainings.
ACO spotlight: Health-related social needs (HRSN) program
HRSN Program services are for food and housing insecure MassHealth members enrolled in the Mass General Brigham ACO who meet specific eligibility criteria.
The HRSN program services provide non-medical services aimed at improving health outcomes by addressing non-medical factors that can influence a person’s overall well-being. This program provides an array of nutrition services and housing assistance to support certain eligible MassHealth members.
For additional information about the HRSN program services for your MGB ACO members, please contact mgbhrsn@mgb.org
Meet the Provider Relations team: Ligia Hartgrove
Ligia Hartgrove, Senior Provider Network Account Executive, has been with Mass General Brigham Health Plan for nearly a year and brings over 30 years of health insurance experience, including 23 years in provider relations. She manages our partnership with Tempus Unlimited and serves as a key liaison between our medical network and community-based organizations, helping strengthen relationships and support seamless coordination across our provider and community partners.
If you're in Ligia’s network area and would like to get in touch with her, please email lhartgrove@mgb.org.
Action required: Attest to your provider directory information in the Provider Portal
In compliance with Massachusetts law and the federal No Surprises Act, health insurance plans are required to keep provider directories current. To meet these broad provider directory requirements, Mass General Brigham Health Plan requests your assistance in verifying your information in the provider directory.
If you have an established process with CAQH, please continue utilizing that process, and we will receive your updates through that channel. It is essential, as part of the DOI initiative, to ensure all information remains current.
For facilities and groups, please visit the Provider Portal, where you can review, update, and attest to your information. Only a User Administrator can attest to this information. Every 90 days the User Administrator will be prompted to complete the attestation. If you need access to the Provider Portal, please register here.
Please note: Any provider not verified within 90 days will display the disclaimer below in our directory until verification is complete.
If you have any questions, please contact Provider Relations at HealthPlanProvRelations@mgb.org.
Help us improve the member experience — confirm your next available appointments
Please take a few minutes to complete this brief survey. Completing this survey will help keep our members informed of the most up to date information on when they can expect to be seen by your practice.
Select a designated Provider Portal User Administrator
Please ensure your practice has a designated User Administrator for the Mass General Brigham Health Plan Provider Portal. The User Administrator is responsible for managing user requests for your practice and will be required to attest to your practice information via the Provider Portal. Designating a User Administrator will ensure timely access for registered users to utilize the Provider Portal.
Please complete and email the User Administrator form to HealthPlanProvRelations@mgb.org. The User Administrator will need to register for an account on the Provider Portal if they do not already have one. Please see additional helpful information on how to register for the Provider Portal below.
Frequently asked questions about the Provider Portal
Q: How do I register for the portal?
A: It only takes about five minutes to register for the Provider Portal. Have your practice's tax ID number handy before you start.
- Register now
- Access requests are managed by the User Administrator for your practice. Contact your User Administrator if you have any questions.
Q: How do I become an administrator?
A: Please complete the User Administrator form. When your portal account is activated, you can request User Admin access under the Manage Account link on the portal home page.
Q: How do I contact customer support for the Provider Portal?
A: For registration support, technical issues, or other questions and concerns, contact HealthPlanprweb@mgb.org.
Q: What do I do if my account or password expires?
A: Your login credentials will expire and be deleted if you do not log in for 180 consecutive days. If your account is deleted, you will be required to re-register.
If you forget your password, you can reset it by clicking the "I Forgot My Password" link within the Provider Portal login page. You will be asked to provide a contact phone number and answer a security question.
Q: Who do I contact with questions regarding the Provider Portal?
A: You can contact HealthPlanprweb@mgb.org.
Help us keep directory information up to date
The Centers for Medicare & Medicaid Services and other regulatory bodies, as well as the federal No Surprises Act of 2021, require health plans to maintain and update data in provider directories. We rely on providers to review their data and notify us of changes as they happen to help ensure members have access to accurate information.
Provider demographic information in our Provider Directory must reflect accurate data at all times and should mirror the information members may receive directly from the practice or via patient appointment call centers.
On at least a quarterly basis, providers should review and verify the accuracy of their demographic data displayed in our Provider Directory, including:
- Address
- Panel status (open or closed) for each individual provider
- Institutional affiliations
- Phone number
- Other practice data
Change requests should be reported via the Mass General Brigham Health Plan Provider Portal Provider.MGBHP.org or by submitting a Provider Change via the Provider-Enrollment-Form to Mass General Brigham Health Plans Provider Enrollment Team by email at HealthPlanPEC@mgb.org.
If Mass General Brigham Health Plan identifies potentially inaccurate provider information in the directory, we may reach out to your practice to validate or obtain accurate information.
In addition, please keep the following in mind:
- Practice location — As new providers join your practice, it is important that only practice locations where the provider regularly administers direct patient care are submitted for inclusion in the Mass General Brigham Health Plan provider directory. Locations in which a provider may occasionally render indirect care — such as interpretation of tests or inpatient-only care — should be specified to ensure the location information is included in the provider’s demographic profile, but not in the provider directory.
- Timely notice — As a reminder, notification of address, acceptance of new patients, provider terminations, and other demographic information changes should be submitted at least 30 days in advance.
For questions, contact our Provider Service Center at 855-444-4647 or Provider.MGBHP.org.
Medical policy updates
Fourteen (14) medical policies were reviewed and passed by Mass General Brigham Health Plan’s Medical Policy Committee. View a summary of the medical policy updates. These policies are now posted to MGBHP.org.
For more information or to download our medical policies, go to MGBHP.org/providers/medical-policies and select the policy under the medical policy listings.
Drug code and code updates
View code updates for February 2026
View the January 2026 new codes summary for commercial
View the January 2026 new codes summary for Medicare Advantage
View the January 2026 coverage summary for D-SNP
Medicare pharmacy updates
View updates here.
Formulary updates
View the formulary updates here.