March 2026: Weight management program for members; interpreter services through LanguageLine

Mass General Brigham ACO recognized as “ACO to Know” by Becker’s Healthcare

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:

• Weight management program now available for members
• Register now: Medicare 101 provider webinar on April 8
• Partner with LanguageLine Solutions for interpreter services
• Level 1 appeals for medical specialty medications update
• MassHealth RY25 encounter data deadline is August 31, 2026
• Important update: MassHealth ending BH and LTSS Community Partners Program
• Mass General Brigham Health Plan’s drug fee schedules to be updated
• Reminder about submitting prior authorization requests to Prime Therapeutics via fax
• Provider FAQs and webinar: Dual Eligible Special Needs Plans (D-SNPs)
• Required model of care (MOC) training for SCO and One Care providers
  
• 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

Weight management program now available for members

We’re pleased to share that a new weight management program is now available to eligible members. Our goal is to support members who are seeking help with weight management and to provide easy access to effective tools and resources. This program is available at no cost to members aged 18 and older who are overweight or obese (BMI of 25 or higher) and enrolled in a commercial fully insured plan. This new weight management program is made possible through our collaboration with Teladoc Health.  

Once enrolled, members receive a cellular connected smart scale, a personalized action plan, and ongoing expert coaching and support throughout the program. By downloading the Teladoc Health app, members can:

• Track food, activity, and weight
• Message a coach for guidance
• Share reports with their doctor
• Snap a photo to log meals
• Set goals and track progress
• Get personalized eating tips

To get started, members can visit TeladocHealth.com/Begin/MGBHEALTH or call 800-835-2362.

Register now: Medicare 101 provider webinar on April 8

Please join us on Wednesday, April 8, from 10 a.m. to 11 a.m. ET for an online educational session hosted by the Mass General Brigham Health Plan Medicare Advantage Field Sales Executive. This session will provide a foundational overview of Medicare, including:

• What Medicare is and the different parts of Medicare
• Eligibility and enrollment
• Associated costs
• Medicare Advantage
• How to apply for Medicare
• Available resources and support
  

Register here.

Partner with LanguageLine Solutions for interpreter services

Mass General Brigham Health Plan partners with LanguageLine Solutions to ensure providers have reliable access to professional interpretation services. These services support effective communication with patients who prefer a language other than English.

The resources linked below include step‑by‑step instructions for accessing a phone interpreter, along with a full list of languages available for both audio and video interpretation. We appreciate all of the work you do and hope this service will be beneficial to your practice.

• Instructions for setting up language services

• Information about the array of languages covered through LanguageLine

Level 1 appeals for medical specialty medications update

Commercial & Medicaid:

Beginning March 1, 2026, Prime Therapeutics will review Level 1 appeals for their denials. You can submit appeals by mail, fax, or phone:

• Mail:

  Prime Therapeutics Management
  Appeals Department
  ATTN: MP - 3001 P.O. Box 64811
  St. Paul, MN 55164-0811
  
  

• Fax: (888) 656-6671

• Phone: (833) 895-2611 (TTY:711)

Appeals for Optum Fusion denials or Medicare and Duals members remain with the plan, following current processes. 

MassHealth RY25 encounter data deadline is August 31, 2026

MassHealth has communicated to all plans that 2025 claims must be adjudicated by August 31, 2026. This means all providers must submit claims with a
2025 date of service no later than August 1, 2026, to meet this adjudication deadline. If there are questions or concerns about your 2025 claims, please contact Customer Service or your designated Provider Account Executive.

Important update: MassHealth ending BH and LTSS Community Partners Program

MassHealth has announced that, as part of broader program and funding changes, the Behavioral Health (BH) and Long-Term Services and Supports (LTSS) Community Partners (CP) Program will conclude effective June 30, 2026.

Below are the key operational details:

• Program end date: All patients enrolled in the CP program will be automatically disenrolled effective June 30, 2026.
• Continuation of services: With the exception of natural attrition, currently enrolled patients will continue receiving CP services through June 30, 2026.
• New enrollments closed: Effective March 1, 2026, no new Community Partners enrollments may be submitted.
  • This includes referrals previously intended for a March 1 enrollment date.
  • The Community Partners team will send confirmation regarding referrals that cannot be processed.
• Patient communications: MassHealth is developing a coordinated communication strategy, including outreach to patients. Materials will be shared as soon as they are available.
• Ongoing collaboration: Mass General Brigham Health Plan is actively coordinating with Community Partners organizations to plan for transition and continuity of care.

We recognize that this change will have a significant impact on patients who rely on Community Partners for behavioral health and LTSS coordination. Our teams are working to identify alternative resources and support pathways to mitigate disruption.

We will continue to share updates as additional guidance becomes available from MassHealth.

Mass General Brigham Health Plan’s drug fee schedules to be updated

Mass General Brigham Health Plan reviews its drug fee schedules quarterly, to ensure that they are current, comprehensive, and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes, to supplement the fees already on the fee schedule.

The next update will occur on April 1, 2026. Changes may involve both new and existing CPT and HCPCS codes and will include the planned quarterly update to physician administered drugs, immune globulin, vaccine and toxoid fees.

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. ET for routine requests, and 24 hours a 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.

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:

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.

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

Twenty-five (25) 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 March 2026

View the January 2026 HCPCS drug codes summary for all lines of business

View the January 2026 HCPCS drug codes summary for commercial

View the January 2026 HCPCS drug codes summary for Medicare Advantage

View the January 2026 drug codes summary for D-SNP

Medicare pharmacy updates

View updates here. 

Formulary updates

View the formulary updates here.