Built around Massachusetts payers
Massachusetts has a payer mix unlike most states. Our reviews account for the rules and documentation expectations of the plans your practice sees most often. Always confirm current requirements in each payer's provider manual.
- MassHealth, including Accountable Care Organizations (ACOs) and managed care plans, and its short claim submission window
- Blue Cross Blue Shield of Massachusetts, including prior authorization and medical policy requirements
- Point32Health, the parent of Harvard Pilgrim Health Care and Tufts Health Plan
- Medicare through National Government Services, the Medicare Administrative Contractor for New England
- Other regional plans, including Fallon Health, Health New England and Mass General Brigham Health Plan
Services for Massachusetts practices
- Medical coding reviews for E/M, procedures, modifiers and HCC capture
- Documentation and chart audits to support medical necessity
- Denial prevention with payer-level trend analysis
- Compliance audits before a payer review
- Provider education, virtual or on site in Greater Boston
Who we work with
Independent physician groups, specialty practices, urgent care centers and clinics across Greater Boston and the rest of the state, including Cambridge, Newton, Waltham, Framingham, MetroWest, Worcester, the North and South Shores and Western Massachusetts.
Practices referring to Boston's academic medical centers
Many community practices refer patients to Boston's large academic and hospital systems. Clear referral documentation, accurate diagnosis coding and the right authorizations help those encounters get paid without delay.
Frequently Asked Questions
Do you only work with Massachusetts practices?
No. Mass Medical Coding serves practices across the United States. This page covers the extra local payer knowledge we bring to Boston and Massachusetts clients.
Do you know MassHealth billing rules?
Yes. We review coding and documentation with MassHealth ACO and managed care requirements in mind, including its short timely-filing window. Confirm current rules in MassHealth provider bulletins.
Can you come on site?
Provider education and kickoff meetings can be held on site in Greater Boston. Most review work is done remotely and securely.
How do we get started?
Request a free revenue assessment. We'll agree on scope, review a sample of encounters and share findings with you.