May 2026: Mental Health Awareness Month

From experimentation to dependency: How substance use can escalate over time

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Nobody sets out to develop a problem with alcohol. For many, it begins as experimentation—a drink at a party, a way to unwind after work, or a social ritual that feels normal and harmless. Over time, what starts as occasional can shift into something more habitual. Understanding how substance use can escalate, which often happens gradually and without obvious warning signs, is an important step in recognizing risk and reducing harm.

For many people in the United States, their first encounter with alcohol happens before they’re legally allowed to drink. Underage drinking remains a significant public health concern, with millions of adolescents and young adults reporting risky use. According to 2024 data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 2.9 million people between the ages of 12 and 20 reported binge drinking in the month prior to taking the National Survey on Drug Use and Health, while 576,000 reported heavy alcohol use during that same period. 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 (Senior Care Options) 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 

Utilization Management: To support timely and accurate responses to Utilization Management (UM) related questions, please use the designated communication channels outlined below. 

Phone: 855-444-4647
Email: MGBHPInquiryUM@mgb.org

 

In this issue:

Mental Health Awareness Month: Member resources and provider webinar series

Mental health is an essential part of overall well-being, and support is available. Explore the mental health resources offered to our members including:

Lyra Health - A virtual‐first behavioral health platform chosen in collaboration with Mass General Brigham experts to improve access to care and outcomes. It offers a range of virtual and in-person options, including self‐service tools, mental health coaching, therapy, and medication management. Members can quickly schedule appointments, often within one to three days. Included with fully insured plans and available to self‐funded groups at an additional cost. Learn more.

Optum - Search for providers who offer treatments including outpatient services, day programs, residential programs, autism care and support, substance and recovery services, and more. Access Optum's telehealth capable providers through the virtual visit platform on Live and Work Well. Browse the articles on Live and Work Well as a guest using the access code: MGBHPMA. Available to all Mass General Brigham Health Plan members. Learn more.

Recovery coaching - Recovery isn’t something to face alone. Our recovery coaches understand the hurt caused by stigma and shame and can thoughtfully act as guides, mentors, and advocates. Available to all Mass General Brigham Health Plan members. Members can self-refer to our care management program or get in touch with a certified recovery coach by emailing HealthPlanCareManagement@mgb.org.

Webinar series for providers

Optum Behavioral Health offers a three-part on-demand webinar series, Behavioral Health Identification, Treatment and Referral in Primary Care, covering the screening, referral, diagnosis, and treatment of mental health disorders. Earn up to 1.50 CME/NCPD/APA/ASWB credits for each session completed. There are no fees for participating in or receiving credit for this activity. Please visit Optum’s website for more details and to register.

Updated practice guidelines on provider resources site

Updated and expanded practice guidelines are now live under Other resources on the provider resources site. Mass General Brigham Health Plan adopts, endorses, and implements these evidence-based guidelines from national sources, professional organizations, or developed by regional collaborative groups. Guidelines serve as a means of establishing standards among medical and behavioral health providers to improve health outcomes. They are not intended to replace clinical judgment.

Register now: Medicare Advantage provider webinar on May 27

Please join us on Wednesday, May 27, from 10 a.m. to 11 a.m. ET for an online educational session hosted by the Mass General Brigham Health Plan Provider Engagement Manager. This session will provide an overview of our recent membership growth driven by the Annual Enrollment Period and Open Enrollment. We will also highlight our current health plan offerings and what they mean for participating providers.

Agenda includes:

  • Key drivers of enrollment
  • Current membership
  • Current plan offerings
  • Provider partnership and support

Register here

Important notice: Change in EIBI administration

Beginning July 1, Early Intensive Behavioral Intervention (EIBI) services will move from Mass General Brigham Health Plan to Optum Behavioral Health. Optum will manage the EIBI benefit, provider network, and claims. Mass General Brigham Health Plan will retire its EIBI policy effective July 1, 2026, and an equivalent medical policy by Optum will be in place effective July 1, 2026. 

This change does not affect Early Intervention (EI) benefits or therapies such as physical, occupational, or speech therapy, which will continue as usual with Mass General Brigham Health Plan.

We understand that changes may present challenges, and we are committed to clear communication and support throughout this transition. For any questions, please contact our Provider Relations team at HealthPlanProvRelations@mgb.org.

Mass General Brigham Health Plan is working closely with Optum to ensure a smooth transition. Please stay tuned for further updates.

Thank you for your continued partnership and support of our members.

Mass General Brigham Health Plan Supplier Diversity Program (SDP)

The Mass General Brigham Health Plan Supplier Diversity Program (SDP) has been created to promote equitable procurement practices by ensuring that diverse suppliers—including minority-owned, women-owned, veteran-owned, and other disadvantaged businesses—are actively considered and engaged in all sourcing activities.

This initiative supports the plan's commitment to diverse supplier selections with the objective of achieving and fostering greater supplier diversity.

The Massachusetts Executive Office of Health and Human Services (EOHHS) website dedicated to certifying/recertifying diverse suppliers can be found here: Certification Program for SDO | Mass.gov

EOHHS Diverse Certification Categories are defined as a business which is at least 51% owned, operated, and controlled daily by one or more (in combination) American citizens of the following ethnic minority and/or gender (e.g. woman-owned) and/or military veteran classifications: 

  • MBE - Minority Business Enterprise
  • WBE - Woman Business Enterprise
  • M/WBE - Minority and Woman Business Enterprise
  • SDVOBE - Service-Disabled Veteran-Owned Business Enterprise
  • VBE - Veteran-Owned Business Enterprise
  • M/NPO - Minority Non-Profit Organization
  • W/NPO - Women Non-Profit Organization
  • M/W/NPO - Minority and Women Non-Profit Organization
  • DOBE - Disability-Owned Business Enterprise
  • LGBTBE - Lesbian, Gay, Bisexual, or Transgender Business Enterprise

Benefits of being certified as a Massachusetts Diverse Supplier through the EOHHS Supplier Diversity Office (SDO):

  • Competitive advantages: Access to exclusive contracts, enhanced visibility in supplier databases, and specialized networking opportunities.

  • Increased opportunities: The SDO’s goals include increasing diverse and small business spending through annual state agency spending benchmarks.

  • Increased marketability: Diverse suppliers can enhance their marketability when bidding on public contracts. The SDO connects certified diverse businesses with business opportunities and resources that can help them grow and thrive.

  • Support for underrepresented groups: Supplier diversity initiatives support underrepresented groups, such as Black, Latino, and LGBTQ+ individuals, who often face significant hurdles in accessing capital and contracting with the state.

  • Economic prosperity: Supplier diversity drives financial returns, fosters innovation, enhances brand loyalty, and contributes to social and environmental impact.

Sign up today: Certification Program for SDO | Mass.gov

MassHealth RY25 encounter data deadline is July 30, 2026

MassHealth has communicated to all plans that 2025 claims must be adjudicated by July 30, 2026. This means all providers must submit claims with a
2025 date of service no later than July 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.

Annual updates to physician and outpatient fee schedules

Mass General Brigham Health Plan reviews its physician and outpatient 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.

Consistent with prior years, Mass General Brigham Health Plan updated its Commercial, PPO, and Medicare physician, ambulance, drug, DME, laboratory, radiology, and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2026.

With a few exceptions, Mass General Brigham Health Plan will continue to base fees on the Centers for Medicare & Medicaid Services (CMS) and MassHealth fee schedules, adjusted to achieve the contracted level of reimbursement.

Commercial/PPO physician fee schedules

    • Rate updates to existing CPT and HCPCS codes will occur on July 1, 2026.
    • Mass General Brigham Health Plan will continue to base physician reimbursement on CMS RVU’s & anesthesia conversion factor.
    • Mass General Brigham Health Plan will continue to base drug, vaccine, and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.
    • Mass General Brigham Health Plan will continue to base DME reimbursement on the CMS DME POS/PEN fee schedules.

Commercial/PPO outpatient fee schedules

    • Consistent with prior years, reimbursement will be based on a combination of outpatient, ancillary, and surgical fee schedules.
    • Mass General Brigham Health Plan will continue to base drug, vaccine, and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.
    • Mass General Brigham Health Plan will continue to base DME reimbursement on the CMS DME POS/PEN fee schedules.

MGB ACO fee schedules

    • Mass General Brigham Health Plan will continue to base physician reimbursement on MassHealth published rates, where they exist.
    • Consistent with prior years, Mass General Brigham Health Plan updated its Medicaid physician, ambulance, drug, DME, laboratory, radiology, and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2026. Rate updates to existing CPT and HCPCS codes will occur within 30 days of receipt of notification of rate change from MassHealth.

Medicare Advantage fee schedules

    • Mass General Brigham Health Plan updated its Medicare Advantage inpatient, outpatient, ancillary, and professional fee schedules/pricers to incorporate new codes and update rates, effective January 1, 2026. Mass General Brigham Health Plan updates its Medicare Advantage fee schedules as directed by CMS.

Meet the Provider Relations team: Mandy Morrison

Mandy Morrison

Mandy Morrison has been a valued member of the Duals Senior Provider Relations team since March 2025, bringing a wealth of One Care and SCO expertise. With extensive experience across Independent Living and Provider Relations, her background includes leadership, provider network management, and provider education and training. In her current role, she manages ASAP provider relationships across the Boston and North Central regions, fostering collaborative partnerships.

If you’re in Mandy’s network area and would like to get in touch with her, please email: mmorrison-allen@mgb.org.

 

Provider FAQs and recorded webinar: Dual Eligible Special Needs Plans (D-SNPs)

Mass General Brigham Health Plan launched SCO (Senior Care Options) 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.

If you were unable to attend one of our live webinar sessions or would like to rewatch it, a recorded version is available below and has been added to our
provider resources page for on-demand viewing. View the slide deck here.

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 SCO (Senior Care Options) 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.

Medicare Advantage FQHC Billing – Reminder

As a reminder, Federally Qualified Health Centers (FQHCs) billing Medicare Advantage must follow CMS billing guidelines and Mass General Brigham Health Plan payment policies. Recent claim reviews indicate that some submissions do not align with these requirements.

To support correct billing, please review the following resources:

Medicare Advantage FQHC/RHC billing guide

Provider payment guidelines: Community health centers

For questions or additional support, please reach out to Provider Relations.

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.

Provider directory disclaimer

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 May 2026
View the April 2026 HCPCS new drug codes coverage summary
View the April 2026 new codes summary for commercial
View the April 2026 new codes summary for Medicare Advantage
View the April 2026 new codes summary for D-SNP

Medicare pharmacy updates

View updates here. 

Commercial pharmacy updates

View updates here. 

MassHealth pharmacy updates

View updates here. 

 

 

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December 2025: Prime webinar sessions added; required MOC training for SCO and One Care providers
March 2026: Weight management program for members; interpreter services through LanguageLine