The C3 ID number is the same as the patient's MassHealth ID.
Pharmacies should use BIN 009555, PCN MASSPROD, and Group “MassHealth” when filling prescriptions for C3 members.
MassHealth members are eligible for C3 enrollment if they:
- Are eligible for the MassHealth managed care program
- Have a primary care provider (PCP) at a participating C3 health center
To be eligible for MassHealth managed care, MassHealth members must:
- Have MassHealth Standard, CarePlus, CommonHealth, or Family Assistance coverage types
- Be younger than 65 with no other health insurance
- Live in the community
For details on MassHealth managed care eligibility, please visit mass.gov.
To verify member eligibility with C3, please log in to the MassHealth Eligibility Verification System (EVS). For access to the MassHealth EVS system, please contact MassHealth at 800-841-2900 or go to the MassHealth provider service center.
Contracting and Provider Network
Community Care Cooperative (C3) members receive primary care services from any one of 17 health centers. C3 members have access to the largest network of specialists and hospitals because we use MassHealth’s PCC Plan Network and the Mass. Behavioral Health Partnership (MBHP) as our networks for medical and behavioral health care. If you are participating with the PCC Plan or MBHP, you are part of C3’s network!
View the list of C3 participating health centers, MassHealth Provider and Dental Directories, and MBHP Directory.
We hope you are participating in one of the provider networks on which C3 member rely. If you are not, MassHealth is committed to honoring scheduled appointments, referrals, and prior authorizations during the Continuity of Care period for the ACO program and to pay for those services. For more information, please refer to this bulletin from MassHealth. We appreciate your attention and service to C3 members during this transition period.
To become a provider with MassHealth, please call 800-841-2900 or visit mass.gov. You can review MassHealth’s billing codes, rates, and billing procedures online. To become a provider with MBHP, please call 800-495-0086 or go online.
Benefits, Prior Authorizations, and Claims Submission
All of the benefit, referral, prior authorization, and claims submission rules for the networks referenced above apply to providers serving C3 members:
Benefits: All MassHealth benefits are covered for C3 members as they are covered directly under MassHealth or MBHP based on their MassHealth coverage type. MassHealth limitations, prior authorizations, and referrals apply.
Prior authorizations: The process for obtaining authorizations from MassHealth or MBHP does not change for C3 members. All requests for prior authorization should be submitted directly to MassHealth or, for behavioral health services, to MBHP.
Claims processing: All claims should be submitted to MassHealth. All services covered for C3 members are paid for by MassHealth.
MassHealth has developed a Provider Page that includes important information on eligibility, coverage rules, claims submission, applicable forms, and becoming a MassHealth provider. To read about dental coverage and rules, please refer to the MassHealth provider page for dental providers.
If you are a behavioral health provider and are looking for MBHP guidance, including information on prior authorizations, please see MBHP guidance.
Pharmacy Benefit and Rules:
C3 uses the MassHealth List of Covered Drugs. The same MassHealth coverage rules apply, including limitations, prior authorization, and step therapy. All requests for prior authorizations should be submitted directly to MassHealth. Access the MassHealth Drug List to learn more about coverage rules.
Pharmacy prescription processing:
Pharmacies should use the following information when filing prescriptions for C3 members:
Member ID: MassHealth ID number
Still have questions?
C3 Information Line
Info Line: 866-67-MY-ACO (866-676-9226)
711 for individuals with a hearing or speech disability
Monday-Friday 9:00 am – 5:00 pm
MassHealth Call Center: 800-841-2900 or (TTY) 800-497-4648
Monday-Friday 8:00 am – 5:00 pm