MassHealth ACO Conversion

Effective March 1, 2018 MassHealth will be putting many of its recipients into new Accountable Care Organizations (ACO’s). Some of these will be partnering with Managed Care Organizations (MCO’s). While MassHealth has made tremendous efforts in preparation of this transition, given the complexity of this conversion and the impact on a large population there is always the potential for some setbacks.

Recipients have been sent new cards depending on the ACO/MCO they have transitioned into. The cards will have the member number that will be required to bill the new insurer. The new member number will not be the same as their previous MassHealth number so there may be some difficulties for the pharmacies in getting this information if the individual does not bring the card into the pharmacy.  If you bill the prior insurer and the member has a coverage change you will get a reject message with the new insurer.  MassHealth Pharmacy Facts #110 has a listing of the billing information for each new ACO/MCO (with the exception of the member number) and MassHealth Pharmacy Facts #111 has the telephone number for each ACO. This information should be helpful when the member does not or cannot provide their new card.

Pharmacy Frequency Asked Questions for ACO launch

MassHealth will be having regular communication with stakeholders during this conversion. Please contact the Association Office with any issues that arise so they can be communicated with MassHealth.