Revenue Cycle Management in Massachusetts for Healthcare Providers
Mediknocx runs the full revenue cycle for Massachusetts physician practices, from eligibility checks to final payment. Our workflows are built around Blue Cross Blue Shield of Massachusetts, the state's largest private insurer with about 3 million members, and MassHealth's short filing window.
HIPAA Compliant
Your data stays secure
Faster Payments & Fewer Denials
Improve cash flow
Higher Reimbursement
Get the revenue you deserve
Massachusetts Billing Compliance Experts
State-specific payer knowledge
Get Your Free Revenue Assessment
Find out how much revenue your practice could be recovering with expert revenue cycle management support. No obligation, just real insights.
Revenue Cycle Management in Massachusetts for Healthcare Providers: MassHealth's 90-Day Filing Deadline
Under 130 CMR 450.309 and M.G.L. c. 118E, § 38, MassHealth must receive a claim within 90 days of the date of service, or within 90 days of the other insurer's explanation of benefits when MassHealth is secondary. A claim first submitted after day 90 is denied. Claims filed on time and denied for a correctable error can be resubmitted up to 12 months from the service date, or 18 months when other insurance is involved.
Late claims survive only through a narrow 90-day waiver, such as for retroactive enrollment. Commercial carriers run a different clock. State law requires them to pay, deny, or request more information within 45 days of receiving a claim, with 1.5% monthly interest on claims left unaddressed. We track both clocks on every account.
Expertise
Built for local care models
Deadline Tracking
We flag at-risk claims early
Fewer Denials
Correct coding, less revenue loss
The Full Revenue Cycle We Manage in Massachusetts
- Patient Access & Eligibility Verification: MassHealth coverage checked through EVS before each visit, plus primary and secondary commercial coverage.
- Charge Capture & Coding: CPT, ICD-10, and HCPCS codes with payer-specific modifiers.
- Claims Submission: MassHealth claims sent well before day 90, commercial claims within days of service.
- Payment Posting: ERAs reconciled against contracted rates, with late-payment interest checked on commercial claims.
- Denial Management & Appeals: Correctable MassHealth denials resubmitted inside the 12-month window, and waiver requests filed with supporting documentation.
- AR Follow-Up: Open claims worked by age and dollar value.
- Reporting: Monthly collections, denial, and aging reports by payer.
How It Works
From Audit toFaster Payments in 4 Steps
A simple, proven process to streamline your revenue cycle and maximize reimbursements in Massachusetts.
Free Audit
We review recent claims, denials, and A/R.
Custom Plan
A written plan built around your payer mix.
Seamless Transition
We take over claims without pausing cash flow.
Ongoing Reporting
Monthly reports on every payer.
Get Your FreeRevenue Cycle Audit Report
Losing MassHealth claims to the 90-day deadline? Call +1 434-201-9720 or email info@mediknocx.com for a free revenue cycle audit.
What Makes Our Massachusetts
Revenue Cycle Management Different
What Massachusetts practices get with our RCM team.
One Team, Every Stage
The same team handles eligibility, coding, submission, posting, appeals, and follow-up. You don't coordinate separate vendors, and no claim sits unowned between one handoff and the next in your revenue cycle.
MassHealth Deadline Discipline
MassHealth claims are queued for submission long before day 90. Secondary claims are timed from the primary payer's EOB date, and waiver requests are prepared with the documentation the state requires for each exception.
BCBSMA Payer Focus
Blue Cross Blue Shield of Massachusetts covers about 3 million members, so its edits and prior authorization rules shape most commercial claims. Our billers work its policies daily and adjust quickly when they change.
Interest Recovery on Late Claims
When a commercial carrier misses the 45-day action window, Massachusetts law entitles you to interest. We flag overdue claims, confirm whether interest was included, and follow up when it was left off.
Monthly Performance Reports
You get a monthly report showing collections, days in A/R, denial rates by payer, and aging buckets, with notes on which Massachusetts payers are slowing payment and the steps underway to fix it.
47-Specialty Coverage
Our teams are organized by specialty across all 47 we support. A Worcester orthopedic group and a Boston behavioral health practice each get coders who know their CPT ranges, modifiers, and payer edits.
Specialty Expertise That Works for You
Mediknocx supports all 47 specialties we serve, from family practice to oncology, cardiology, and radiology, with teams assigned by specialty.
How Does Mediknocx Ensure Compliance
With Massachusetts Medical Billing Regulations?
No Surprises Act and the Patients First Act
We apply the federal No Surprises Act alongside Section 25 of Chapter 260 of the Acts of 2020, which requires providers to disclose their network status to patients before non-emergency care. Providers who skip the required notice can't bill beyond in-network cost sharing.
Massachusetts timely filing law
MassHealth claims follow the 90-day rule in 130 CMR 450.309, with correctable resubmissions tracked against the 12-month and 18-month limits.
Massachusetts billing transparency
Carriers issue a common summary of payments form under M.G.L. c. 176O, § 27 showing each patient's share. We reconcile patient statements against it so balances match.
Payer-specific guidelines
We follow BCBSMA's medical and payment policies, MassHealth's billing guides and provider bulletins, and each MassHealth health plan's contract terms.
Healthcare Billing Services Across Massachusetts Cities
We support practices in Boston, Worcester, Springfield, and communities across the Commonwealth.
- Boston
- Worcester
- Springfield
- Cambridge
- Lowell
Nationwide Revenue Cycle Management
Mediknocx also provides revenue cycle management for practices in Texas, Florida, Georgia, North Carolina, Ohio, Michigan, Minnesota, Missouri, Tennessee, and Wisconsin.
Put your Massachusetts revenue cycle in experienced hands. Contact us at +1 434-201-9720 or info@mediknocx.com to start with a free audit.
Frequently Asked Questions
Find answers to the most common questions about our revenue cycle management services in Massachusetts.
