Taking MassHealth Patients
MassHealth is a state-funded program and, as such, is subject to annual budget decisions. The Massachusetts state budget runs on a fiscal-year cycle that begins on July 1 and ends on June 30. MassHealth adult dental benefits have been a frequent target over the past years, with significant benefit reductions that have created havoc for patients and providers.
In January of 2021, the MassHealth Dental Program restored adult benefits. MassHealth patients over 21 years old can now access more dental benefits, including restorations (fillings), extractions, root canals, and crowns. Patients still have access to preventative visits, including cleanings and x-rays, periodontal services for periodontitis, and partial or complete dentures. It is recommended that dental providers educate patients about these changes.
Problems? Contact the Massachusetts Dental Society (MDS) Member Assistance Center at 800.342.8747.
MassHealth provides healthcare benefits to more than one million low- and moderate-income children, families, seniors, and individuals with disabilities in Massachusetts. MassHealth has contracted with Dental Service of Massachusetts (DSM) to manage the dental program. DSM subcontractor BeneCare acts as the third-party administrator for the program. MassHealth has an adult fee schedule and a child fee schedule, and only reimburses participating providers. The participating provider is responsible for the quality of all services for which payment is claimed, the accuracy of such claims, and compliance with all regulations applicable to dental services under MassHealth. View a comprehensive list of MassHealth-covered dental services for children and adults here.
The MassHealth Dental Program restored adult dental benefits, effective January 1, 2021, thanks to the efforts of advocates and the Massachusetts legislature. MassHealth members over the age of 21 can now access a broader range of dental services, including root canals and crowns, in addition to other essential services such as preventive care and partial/complete dentures, which were previously covered. Educate your patients about these benefits and refer them to the Dental Manual for MassHealth Providers, which provides guidance on regulations, administrative, and billing instructions for dental providers. For more information, visit the MassHealth provider web portal.
In March 2025, BeneCare assumed the role of third-party administrator (TPA) for the MassHealth program. Since then, numerous issues have arisen with the claims and reimbursement system. The MDS has been communicating diligently with MassHealth to communicate the issues and insist that the problem be solved. Here you will find some of the communications members have received from the MDS regarding the issue. The MDS leaders will continue to advocate for our members with the TPA and MassHealth until the issue is resolved.
Fill out these forms to effectively communicate your issues to BeneCare
- This online form, which should be used if you are NOT already working with the BeneCare team, is for those with claims payment that remains very low: Help Needed with Very Low or No MassHealth Claims Payment.
- Providers who have received more than one interim payment advance and are concerned about the recoupment schedule can request a more gradual recoupment schedule by completing the MassHealth Recoupment Hardship Request Form.
These are just two of the many communications that the MDS has sent to members about this issue.
Massachusetts dentists are required to renew their dental licenses by March 31 of even years. M.G.L. c. 112, s. 45 mandates that the Board of Registration in Dentistry (BORID) condition the renewal of all dental licenses on a dentist’s application to participate in MassHealth as an Ordering, Referring, and Prescribing (ORP) non-billing provider unless the dentist is already enrolled as an approved billing provider. Accordingly, you will not be permitted to renew your dental license unless and until you submit an ORP enrollment form to MassHealth.
This law went into effect in November 2017. Massachusetts dentists will need to attest to participating as a MassHealth provider or as a non-billing provider as a condition of the license renewal process at each cycle.
Attestation Questions (Note: You must answer ‘yes’ to both related questions)
Are you enrolled in MassHealth as a fully participating provider or non-billing provider, OR have you submitted a thoroughly completed application to be a fully participating provider and a signed provider contract with MassHealth?
Do you consent to the Bureau of Health Professions Licensure and the Massachusetts Executive Office of Health and Human Services, and its enrollment vendor, to obtain, read, copy, and share information regarding your MassHealth application and enrollment status and professional licensure status?
The Affordable Care Act (ACA) included provisions that allowed providers to formally opt in or opt out of federal programs. There is an Affordable Care Act (ACA) provision that requires each licensed dentist in Massachusetts to enroll with MassHealth as an Ordering, Referring, and Prescribing (“ORP”) non-billing provider (if not already enrolled with MassHealth as an approved, billing provider) before seeking to renew his or her dental license.
The MassHealth application requires dentists to provide their Health Care Provider Taxonomy Code, a code that describes the type of services or specialty a healthcare provider offers to patients. Dentists receive their taxonomy code when they register on the NPPES (NPI) registration site. Most dentists’ code is 122300000X—but check yours to be sure!
Mail completed forms to:
MassHealth Dental Program
Attn: Provider Enrollment and Credentialing
PO Box 2906
Milwaukee, WI 53201-2906
Will a dentist need to take this action at each renewal cycle?
MassHealth will require re-credentialing every five years.
Does this requirement apply to dentists holding a limited license?
Yes, MassHealth/BeneCare will be working closely with the League of Community HealthCenters on this.
Who should I contact if I have questions about completing the enrollment form and contract?
For questions regarding the Non-Billing Provider Application or the enrollment process for non-billing providers, please direct inquiries about the form to the Customer Service Center at 800.841.2900 or provider@masshealthquestions.com.
Note: Non-billing providers are not eligible to submit claims to or receive payments from MassHealth.
Improve oral health in Massachusetts by joining many of your peers as a MassHealth provider. Dentists interested in participating in the MassHealth program should contact the MassHealth Customer Service Center at 800.841.2900. Learn more about becoming a MassHealth provider here.
PATIENT LOAD QUESTIONS
Can I cap my case load? (limit the number of MassHealth patients?)
Yes, you now have the ability to cap your case load at any level you see fit. You do not need to
predetermine the number of patients.
What are the different ways I can cap my case load?
Members employ various approaches to manage their caseloads. Some members
choose to only take children, others select an age range (i.e., 10-18 years of age), while some
members select a zip code to cover. Note: As long as you are not discriminating, you may choose your guideline.
Can I serve only my existing patients?
Yes, you can just serve your existing patients.
PUBLICITY QUESTIONS
Do I have to be listed in the MassHealth provider directory?
No, you can elect not to have your name listed in the directory. Some members prefer this method so that they are not overwhelmed with phone calls. Please indicate on your application that you do not wish to be listed in the directory. Note: Please inform your referral network that you are participating in MassHealth, so they are aware that you can now accept MassHealth benefits.
FEE SCHEDULE QUESTIONS
Is there a separate fee schedule for children?
Yes, there are two fee schedules: one for children and one for adults. The child’s schedule is based on the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) rate. The adult schedule is listed as Allowed Fee. Both schedules are available on the MDS website. The child reimbursement rates are more favorable than those for adults. EPSDT is described in federal law at 42 U.S.C. §1396d(a)(4)(b) and (r) and 42 CFR 441.50. In Massachusetts, EPSDT-eligible members are enrolled in MassHealth Standard or MassHealth CommonHealth categories of assistance and are under the age of 21.
COVERAGE QUESTIONS
How do I know what is covered?
Check the MassHealth Provider Online Service Center.
What happens if a MassHealth patient does not show up for his/her appointment? Can I bill them?
You cannot bill a MassHealth patient for a “no-show” even if you have this policy with your private patients.
Can I send a dismissal letter to a patient who fails to attend appointments?
Yes, you can send a dismissal letter to a patient who does not show for an appointment, provided it is your standard policy to send dismissal letters to ‘no shows.’ You cannot treat MassHealth patients differently from your other patients.
ENROLLMENT QUESTIONS
What is the credentialing process?
Instead of a 30-plus-page application that requires Internal Revenue Service documents, W-2s, and other supporting documents, the application has been condensed to 12 pages, accompanied by clear instructions. Not only is the application shorter, but it is clearer and easier to complete.
How long will it take to enroll in MassHealth?
It takes approximately three months to process an application.