About 78% of Medicaid beneficiaries are enrolled in comprehensive managed care organizations, so most Medicaid claims are adjudicated by a commercial insurer with its own rules — not by the state. Practices that bill "Medicaid" as one payer are billing a dozen.
Claims for Massachusetts providers are adjudicated by National Government Services (JK), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Medicare contractor
National Government Services (JK)
Medicaid program
MassHealth
Managed care
Predominantly commercial plans
Auto injuries
No-fault — auto carrier pays first
What changes in Massachusetts
Medicaid in Massachusetts runs as MassHealth and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
Massachusetts is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan, and billing the health plan first produces a denial that looks like a coverage problem but is a sequencing problem.
What we do
- Bill the plan that actually adjudicates rather than the program on the card
- Track filing windows per plan, which are frequently shorter than commercial
- Verify eligibility every visit, because Medicaid coverage churns monthly
- Sequence Medicaid last, since it is the payer of last resort and enforces that
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your Massachusetts aging and denial mix.
Scope
A written scope and price before any work starts.
Transition
No gap in submission during the handover.
Report
Six numbers monthly, segmented by payer.
Medicaid Billing in Massachusetts — Frequently Asked Questions
Which Medicare contractor covers Massachusetts?
+
National Government Services (JK). That is who adjudicates your Medicare claims and who hears a redetermination.
Is Massachusetts Medicaid managed care?
+
MassHealth is delivered largely through commercial managed care plans, so the plan sets the filing window and the authorization rules, not the state.
Ready for books you can actually trust?
Book a free consultation and we will tell you what your revenue cycle needs and what it costs.
- Done-for-you
- Solo or group
- Nationwide
Book Online
Share your details and preferred availability.