Provider Manual for Mass Advantage Medicare Advantage Program

Mass Advantage Benefits information Medical, Pharmacy, and Supplemental Benefits across all 3 Mass Advantage Plan Products.

Mass Advantage contracts with primary and specialty care providers, hospitals, and ancillary providers to care for our members. The following sections outline the basic guidelines for our network providers.

Care Coordination is a key component of Mass Advantage operations. Mass Advantage facilities optimal settings for delivery of care and educates physicians and facilities on the advantages of managing care in a medically appropriate and cost-effective manor. In addition, Mass Advantage collaborates with providers, vendors, and community resources to keep members living safely at home.

Mass Advantage members have the right to communicate dissatisfaction with the quality of care that they receive, the timeliness of services, or decisions made by Mass Advantage or its providers. CMS separates these into two categories: grievances and appeals.

Mass Advantage maintains billing and claims processing guidelines consistent with industry standards. This section contains billing and claims guidelines for claims filed with Mass Advantage. Providers must follow these guidelines to ensure accurate and timely payments.

When it comes to your patient’s health information, they have certain rights. These pages explain your patient’s rights and some of our responsibilities to help them as Mass Advantage members.

Mass Advantage deploys both quality and clinical programs to enhance the quality of care their members receive. These programs include both Medical and Pharmacy-related programs, such as the Medicare Advantage and Part D Star Ratings program and Medication Therapy Management (MTM) program. Learn more about the Quality and Clinical programs Mass Advantage deploys.