Massachusetts has one of the shortest Medicaid billing deadlines in the country. MassHealth wants claims within 90 days of the date of service, and late claims need a waiver. Add behavioral health carve-outs that send the same patient's claims to different payers depending on their plan, and Massachusetts rewards practices that bill fast and check coverage every month.
This guide is for therapy, counseling, psychiatric, and speech therapy practices billing commercial plans and MassHealth in Massachusetts.
MassHealth billing deadlines
MassHealth's billing rules (130 CMR 450.309) set three dates:
| Deadline | When it applies |
|---|---|
| 90 days from the date of service | Every initial claim, unless MassHealth says otherwise |
| 90 days from the other insurer's EOB | When the member has other coverage, which must be billed first |
| 12 months (18 if another insurer was billed first) | The final deadline. A late claim that meets one of the listed exceptions needs a 90-day waiver request before this date |
Claims, claim status, and remittances run through the Provider Online Service Center (POSC). With a 90-day limit, a claim rejected for a typo and found a month later is already in trouble. Fix rejections within two business days.
MassHealth members change plans often, and the plan decides who pays for behavioral health. Re-verify eligibility and plan assignment at every visit for MassHealth patients, not only at intake.
Behavioral health carve-outs
MassHealth members are in different types of plans: accountable care organizations, managed care organizations, and the Primary Care Clinician (PCC) Plan. For many members, behavioral health is managed by a separate organization. PCC Plan members, for example, get behavioral health through the MassHealth Behavioral Health Partnership (MBHP), managed by Carelon. Commercial plans in Massachusetts also often use a behavioral health vendor.
For a therapy practice, that means the payer on the member's card may not be the payer for your claim, and you need to be credentialed with the behavioral health organization, not only the health plan. Most denials for "provider not in network" on MassHealth behavioral health claims come from this.
Commercial claim payment
Massachusetts requires carriers to pay a clean claim within 45 days of receipt. If they deny it, they must give the reason and any information needed within the same time. A clean claim unpaid after 45 days earns interest of 1.5% a month, up to 18% a year. As always, self-funded employer plans follow federal rules instead.
The annual behavioral health wellness exam
Chapter 177 of the Acts of 2022, the state's mental health access law, requires carriers to cover an annual mental health wellness exam starting April 1, 2024. It can be performed by a primary care provider or a licensed behavioral health clinician. The Division of Insurance set out the procedure code, diagnosis code, and modifier to use in Bulletin 2024-02, as the Massachusetts Medical Society explains.
For a therapy practice, it can be a covered first visit for patients who aren't sure they need ongoing treatment. Bill it exactly as the bulletin specifies, or it will be processed as a regular visit with cost-sharing.
Prior authorization changes
The Division of Insurance proposed new prior authorization rules (211 CMR 52) in early 2026. The draft includes a 24-hour decision for urgent requests, automatic approval when a carrier misses its deadline, approvals that last at least 90 days, honoring a previous plan's approval for 90 days after a member switches, and 60 days' notice before new authorization requirements. Electronic prior authorization standards would follow in 2027. These were proposals when we reviewed this guide; check whether the final rule is in effect.
For MassHealth managed care plans, the federal interoperability rule requires decisions within 7 calendar days for standard requests and 72 hours for expedited ones since 2026.
A Massachusetts billing checklist
- Bill MassHealth within 7 days of service. Treat 90 days as an emergency, not a target.
- Re-verify MassHealth eligibility and plan assignment at every visit.
- Credential each clinician with the behavioral health organizations, not only the health plans.
- Bill other insurance first and send the MassHealth claim within 90 days of the EOB.
- For a late claim with a valid exception, file the 90-day waiver before the final deadline.
- Use the wellness exam codes from DOI Bulletin 2024-02 exactly.
- Flag commercial clean claims unpaid after 45 days and check for interest.
When to bring in help
Sharp Networks Group handles billing and credentialing for therapy and behavioral health practices in Massachusetts and across New England, inside the EHR you already use. If you're expanding from Rhode Island or another state, see what changes in our multi-state billing article and the state-by-state guide, or schedule a consultation.
Last reviewed October 2026. Laws, plan policies, and filing limits change. Confirm current rules with each plan, MassHealth, and the Division of Insurance.