Coding and claim mechanics are national. What changes at a state line is everything around them: who adjudicates your Medicare claims and hears your appeals, what your Medicaid program is called and whether a commercial plan sits in front of it, whether an auto injury is the health plan's problem or the auto carrier's — and how a billing company is permitted to charge you.
In Massachusetts, Medicare is administered by National Government Services (JK). Medicaid runs as MassHealth, delivered largely through commercial managed care plans — so most Medicaid claims are adjudicated by an insurer with its own filing window and authorization rules rather than by the state.
Massachusetts is a no-fault state. For an auto injury the auto carrier pays first, not the health plan, and billing the health plan first produces a denial that looks like a coverage problem but is really a sequencing problem.
White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.
At a glance
Medicare contractor
National Government Services (JK)
Medicaid program
MassHealth
Medicaid delivery
Commercial managed care plans
Auto injuries
No-fault — auto carrier pays first
Appeals in Massachusetts
National Government Services (JK) is who hears the first level of appeal for a Medicare denial here. That matters practically: an appeal argument that works with one contractor generally works across every state it covers, and local coverage determinations mean the same service can be covered in Massachusetts and not one state over.
What we handle for Massachusetts practices
- Medical coding by certified coders, from your documentation
- Charge entry, claim scrubbing, and electronic submission
- Clearinghouse rejection follow-up and denial management
- Payment posting reconciled to your bank deposits
- Aged A/R worked by recoverability, not by date
- No-fault and auto-injury claims sequenced to the Massachusetts auto carrier first
- Patient statements, payment plans, and a billing support line
A note on Massachusetts business taxes
Not a service we sell, and not advice — but a practice is still a business with a state footprint, and it comes up often enough to be worth stating. Massachusetts administers sales tax through the Massachusetts Department of Revenue. Most clinical services are not taxable, but retail sales — supplements, cosmetics, optical, DME sold rather than billed — frequently are. Employer registration runs through the Massachusetts Executive Office of Labor and Workforce Development, and the entity itself is registered with the Massachusetts Secretary of the Commonwealth. Your CPA owns all of it; we mention it because the retail side of a practice is where it usually surfaces.
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, denial mix, and payer panel.
Scope and price
A written scope, and the Massachusetts rate card above confirmed in writing.
Transition
Coding and submission move across without a gap.
Report
Six numbers monthly, segmented by payer and provider.
Medical billing pricing in Massachusetts
Percentage of collections
6–8% of what we collect for you
You pay a share of what actually lands in your account. If a claim is never paid, it costs you nothing — which is the point: it puts us on the same side of the denial as you are.
Every ongoing engagement carries a minimum monthly fee of $500. It exists so a new or small practice can be served properly rather than quoted a percentage that does not cover the work.
What changes the work in Massachusetts
- Medicare contractor
- National Government Services (JK)
- Claims for Massachusetts providers are adjudicated here, and this is who hears the first level of appeal.
- Medicaid program
- MassHealth
- Delivered largely through commercial managed care plans, so most Massachusetts Medicaid claims go to a health plan rather than to the state.
- Auto injuries
- No-fault / PIP state
- In Massachusetts the auto carrier is the payer of first resort for an auto injury, not the health plan. Billing the health plan first is a denial waiting to happen.
Massachusetts shares its Medicare contractor with Connecticut, Maine, New Hampshire, New York, Rhode Island and Vermont, so an appeal that works in one usually works in the others.
Front-end services in Massachusetts
These are priced per occurrence and are the same in every state. They can be bought on their own, without a billing contract.
| Eligibility check | $5 per patient |
| Full benefits verification | $10–$14 per patient |
| Prior authorization, standard | $12 per authorization |
| Prior authorization, complex | $18–$25 per authorization |
| Patient registration audit | $4 per patient |
What we report every month
- Days in A/R — How long money takes to arrive.
- A/R over 90 days — What share of what you are owed is going stale.
- Clean claim rate — How often a claim is paid without rework.
- Net collection rate — Of what was collectable, how much we collected. The number that grades the whole engagement.
- Denial rate by reason — Grouped by cause, so it points at a fix rather than a total.
- Charge lag — Days from date of service to claim submission — often your number to fix rather than ours, which is exactly why you can see it.
Massachusetts Guides
Massachusetts Sales Tax Filing
Tracked, reconciled, and filed on the cadence Massachusetts assigns you.
Open guideMassachusetts Tax Agency Directory
Who administers what, with rates and thresholds as of August 2026.
Open guideAll Medical Billing Services
Monthly close, cleanup, AR/AP, payroll, job costing, and more.
Open guideMassachusetts Medical Billing by Specialty
These specialties have medical billing that genuinely differs in Massachusetts — workers compensation schedules, no-fault auto rules, or Medicaid structure.
Massachusetts — Frequently Asked Questions
Which Medicare contractor covers Massachusetts?
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National Government Services (JK). That is who adjudicates your Medicare claims, publishes the local coverage determinations that bind you, and hears a redetermination.
Is Massachusetts Medicaid managed care?
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MassHealth is delivered largely through commercial managed care plans. Nationally about 78% of Medicaid beneficiaries are in comprehensive managed care, and five companies account for roughly half of that enrollment — so "billing Medicaid" here usually means billing a commercial insurer.
How do you price in Massachusetts?
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A percentage of collections, banded by practice size. The rate card above shows what applies.
Do we have to be in Massachusetts to work with you?
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No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking Massachusetts's rules against your actual claims, which is what this page is for.
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