For Providers

Our vision is to transform the health of underserved communities. We work to ensure providers are committed to carrying out that vision in their work and patient care. C3 Members receive primary care services from many of our participating health centers and affiliated providers. We participate in both MassHealth ACO and Medicare ACO REACH contracts. Please select a network below for more information.

Masshealth ACO

Our MassHealth ACO Members also have access to the largest network of specialists and hospitals because we use MassHealth’s PCC Plan Network and the Massachusetts 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 already part of C3’s network!

View the list of C3 participating health centers, MassHealth Provider and Dental Directories, and the MBHP Directory.

We hope you are participating in one of the provider networks on which C3 Members rely. If you are not, MassHealth is committed to honoring scheduled appointments, referrals, and prior authorizations during the Continuity of Care (COC) period for the ACO program and to pay for those services. For more information, please refer to this COC bulletin from MassHealth. We appreciate your attention and service to C3 Members during this transition period.

Visit become a provider with MassHealth or call 800-841-2900. You can review MassHealth’s billing codes, rates, and billing procedures online.

Visit become a provider with MBHP or call 800-495-0086.

If you are providing care to any of our Members in our MassHealth ACO, you must follow MassHealth coverage rules.

MASSHEALTH MEMBER ELIGIBILITY

To be eligible for the C3 MassHealth ACO, patients must…

Have MassHealth Standard, CarePlus, CommonHealth, or Family Assistance plan types

Be younger than 65 years of age

Have no other health insurance

Reside in the community (not in a nursing facility or chronic inpatient hospital)

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.

All of the benefit, referral, prior authorization, and claims submission rules for the participating health centers and affiliated providers, MassHealth medical or dental providers, and MBHP providers apply to providers serving C3 ACO members. All claims should be submitted to MassHealth or MBHP. All services covered for C3 Members are paid for by MassHealth or, for behavioral health services, by MBHP.

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.

Claims Processing

MassHealth has developed a Provider Page that includes important information on eligibility, coverage rules, claims submission, applicable forms, and becoming a MassHealth provider. Read about dental coverage and rules, please refer to the MassHealth 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.

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.

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

BIN: 009555
PCN: MASSPROD
Group: MassHealth

Medicare ACO Reach

Our Medicare beneficiaries may receive services from any providers enrolled with Medicare.

Become a Medicare Provider

If you are providing care to any of our Members in our Medicare ACO program, you must follow Medicare coverage rules.

MEDICARE ACO REACH MEMBER ELIGIBILITY

To provide services to Medicare Members aligned to our ACO REACH program, providers should be enrolled with Medicare.

To be eligible for the C3 Medicare ACO REACH, patients must…

Beneficiary must be enrolled in Medicare Parts A and B

Medicare is the primary payer

Beneficiary must be resident of the U.S.

Beneficiary is not covered under Medicare Advantage or other Medicare managed care plan

Beneficiary must reside in a county that is included in the ACO’s service area (counties in which your centers are located and adjacent counties are included in the service area)

To verify patient Medicare eligibility, please use one of the Medicare available tools: Medicare Administrative Contractor (MAC) online provider portal, MAC Interactive Voice Response (IVR) system, Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)

Benefits

All Medicare benefits are covered for C3 Members as they are covered directly under Medicare Fee-For-Service. Medicare limitations and prior authorizations apply. Please visit Medicare.gov or cms.gov for more information.

Claims Processing

All claims should be submitted to Medicare or its vendor. All services covered for C3 ACO REACH participants Members are paid for by Medicare.

Prior Authorizations

The process for obtaining authorizations from Medicare or a Medicare vendor does not change for Members aligned with C3 REACH program. All requests for prior authorization should be submitted directly to Medicare or its vendor.

Medicare Shared Savings Program

The Medicare Shared Savings Program (MSSP) is a voluntary program that encourages groups of providers and suppliers (e.g., physicians, hospitals, and federally qualified health centers) to come together as an ACO and to be held accountable for the quality, costs, and experience of care of assigned Medicare beneficiaries. Below are resources and additional information related to our MSSP program.

MSSP Public Reporting Page (More information to come.)