Benefits & Payment Policies

Documents and Forms Library

Vaccination Payment Policy
Define vaccine coverage and payment guidelines under Mass Advantage plans based on Medicare Part B Vaccine coverage or Medicare Part D Vaccine coverage.

Outpatient Observation Payment Policy
Defines Mass Advantage’s policy for the coverage of outpatient observation services.

Ambulance Transport Payment Policy 
Defines Mass Advantage’s policy regarding coverage for emergency and nonemergency
ambulance transport benefits.

Unlisted Procedure Code Payment Policy
Defines Mass Advantage's billing requirements and reimbursement process for unlisted codes. Unlisted codes do not have defined rates under the provider's payment methodology.

Experimental Procedures and Items, Investigational Devices, and Clinical Trials Policy
Ensures the Plan and/or its delegated entities processes are consistent and compliant with Centers for Medicare and Medicaid Services (CMS) for investigational devices and procedures.