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MassHealth Provider Acceptance Appeals

Many of the available medical benefits require MassHealth approval before the health care provider carries out services.

If MassHealth turns down or changes a request for approval for a medical service, MassHealth notifies members through the mail. The notice will explain the reason for MassHealth’s decision. If an individual disagrees with MassHealth’s decision, it may be appealed by requesting a fair hearing. Appeals are handled by the Board of Hearings of the Division of Medical Assistance (DMA).

At a fair hearing, both the individual and a representative of MassHealth will present information to the fair hearing officer about the medical service in question. The fair hearing officer will write a decision either agreeing with MassHealth and its decision or agreeing with the member and overturning it. The hearing officer’s written decision is based on the facts of the situation and the rules that MassHealth must follow.

See also:

MassHealth Covered Services

MassHealth Provider Acceptance

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Topic Title: MassHealth Provider Acceptance Appeals
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