MassHealth/Medicaid Updates (May 2026): SENDPro Program Changes

Posted on May 1, 2026

Health New England follows MassHealth requirements related to claims submissions. The changes described in the notice below are vital to claims processing and payment.

Please note:

• Providers may be at risk for denied claims if all information is not provided.
• MassHealth will not accept incomplete claims.
• Health New England/BeHealthy Partnership may deny claims if files don’t contain all required data.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. You may also send an email to providerrelations@hne.com.

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This fall, MassHealth released a Provider Bulletin regarding the SENDPro Program. Below are the details of the Bulletin and how providers can prepare for the upcoming changes that may affect their operations.

Please review this carefully and begin identifying updates your practice needs to make prior to when the SENDPro changes go live.

Key Information:

MassHealth has identified a set of upcoming changes that will substantially impact encounter data validations. Please note that many of these requirements (provider NPI, provider taxonomy, valid code sets) are not new, but will be enforced to better comply with EDI standards and federal requirements for encounter data reporting:

• Completeness of Provider Taxonomies: MCEs must include provider taxonomies in the appropriate data element(s) for all medical encounter submissions. Therefore, providers must include provider taxonomies in the appropriate data element(s) on all claim types except pharmacy.

• Completeness of Provider NPIs: MCEs must include the provider’s NPI in the appropriate data element(s) for all encounter submissions. Therefore, all provider claims must include valid NPI in the appropriate data MassHealth MCE Bulletin 133 September 2025 Page 3 of 4 element(s) for all provider types (e.g. billing, attending, referring, rendering, operating), with the exception of atypical providers.

• Validation of Attending Provider ID: MCEs must include NPI values for attending in the appropriate data element in all 837 I encounter submissions. Therefore, providers must include a valid NPI for the attending provider in the appropriate data element for all inpatient provider claims.

• Submission of Hospital Admission Data and Time: MCEs must include a valid admission hour in all encounters submitted via 837 I. Therefore, providers must include a valid admission hour and date on all inpatient provider claims, with exceptions for certain bill types. For full details and list of exceptions, please refer to the 837 I companion guide.

• Submission of Hospital Discharge Hour: MCEs must include a valid discharge hour in all encounters submitted via 837 I. Therefore, providers must include a valid discharge hour and date for all inpatient provider claims, with exceptions for certain bill types. For details, please refer to the 837 I companion guide.

• Completeness of PID/SL (Provider Identification/Service Location): MCEs must include PID/SL identifiers in provider-related data fields for all encounters.

• MCEs must ensure that all network providers have a valid PID/SL and require providers without a PID/SL to obtain one.

• MCEs must accurately report all PID/SLs to MassHealth on the enhanced provider file.

• PID/SLs are not required on provider-submitted claims, but providers must include the following data elements for MCEs to accurately map the PID/SL for each provider: provider name, provider address, taxonomy, NPI.

• Procedure Codes and Modifiers, Diagnosis Codes and Any Standardized Codes: MCEs must use standardized code sets, as per EDI implementation guide specifications and requirements. Typos and invalid codes will be rejected.

As MassHealth continues testing, additional impacts may be identified. We will communicate further impacts or changes as necessary with providers.

Categories: Provider Newsletter