Massachusetts Medicaid: Updated MassHealth Data Requirements for Accurate Claims
Beginning in early 2026, MassHealth will require MCEs to conduct more stringent claim-accuracy checks before sending encounters through SENDPro. It will help prevent claims rejections and reimbursement delays.
With immediate effect, refer to the table and apply the revised guidelines before filing claims with UnitedHealthcare. Compliance will aid in seamless processing and prompt reimbursement.
| Name | What it Means | What Goes Wrong | What Providers Should Do |
| Taxonomy codes | Shows the provider’s specialty and is linked to the NPI. | Claims without the correct taxonomy code (except pharmacy claims) are turned away. | Add the appropriate taxonomy code for every attending, rendering and billing provider on medical encounters. |
| National Provider Identifier (NPI) | Helps MassHealth match the provider and service location accurately. | Claims are rejected when an NPI is missing, unless it’s an atypical provider who doesn’t receive one. | Enter the full 10-digit NPI for all required provider roles, billing, attending, referring, rendering and operating. |
| Admit/discharge dates/times | Shows how long a member stayed in inpatient care. | Claims get denied when the admission date or hour is missing or incorrect (depending on bill type). | Review bill type rules and include the correct admission hour and date on inpatient claims that require them. |
| Primary diagnosis codes | Explains the main reason for the visit. MassHealth will soon publish an approved list. | Claims are denied if the primary diagnosis code is inactive or not allowed for the date of service (for example, F02.80). | Use valid and updated diagnosis codes and check that all fields and procedure codes are correct. |
| Occurrence codes | Provides added details about the patient’s condition or history. | Rejections occur when the occurrence code doesn’t match the member’s actual situation. | Choose occurrence codes that properly reflect the member’s condition and clinical context. |
| Revenue codes | Identifies the type of service billed. | Invalid or non-reimbursable revenue codes cause rejections. MassHealth has already marked revenue code 779 as invalid. | Verify codes against the MassHealth fee schedule before billing and avoid codes that aren’t reimbursable. |
| National Drug Code (NDC) | Universal identifier of the drug’s manufacturer, product, and package size. | Missing/invalid NDC data for physician-administered drugs. | Make sure the claim has the 11-digit NDC, the right unit of measure, and a quantity above zero. |
Providers can reach support anytime through 24/7 chat in the UnitedHealthcare Provider Portal.
