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  • 1-855-838-1370
  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • Mon to Fri 9:00AM to 06:00PM EST
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Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Massachusetts. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Massachusetts based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

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Shoreline Healthcare Technologies in Massachusetts exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

MassachusettsBilling Challenges we solve



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Fragmented Payer Environment & Complex Reimbursement Structures

Massachusetts has a dense concentration of private payers and each one of them employs distinct prior authorization, claim formatting, and bundled payment protocols. This heterogeneity increases claim denials and administrative rework. At Shoreline Healthcare Technologies we use AI-driven rules engine that automatically applies payer-specific logic and pre-submission validation, identifying the denial trends and adjusting the coding templates. This ensures accurate coding and compliance with state-specific regulations across various payers, streamlining the billing process for providers.


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MassHealth’s Layered Requirements

The state’s Medicaid program MassHealth maintains state-specific billing codes and edits that are different from the CMS standards, especially for Behavioral health integration codes, Telehealth parity rules, Long-Term Services and Supports (LTSS) documentation. Providers must maintain dual billing templates (state vs. federal), complicating EHR workflow. At Shoreline Healthcare Technologies we use Dual-schema configuration that allows simultaneous compliance with both CMS and MassHealth code sets, eliminating duplicate templates.




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Telehealth Billing Complexity Post-COVID

Even though Massachusetts enacted a permanent telehealth reimbursement parity (2021), coding differs by service type and provider location. This leads to high error rates for rural or hybrid practices when applying GT, 95, or POS modifiers. Shoreline Healthcare Technologies have built-in policy tracker that automatically updates with every state or payer rule change and applying correct modifiers and place-of-service codes. Our team clearly distinguishes between parity and non-parity reimbursement models, helping providers to stay up to date with evolving telehealth regulations in Massachusetts.


At Shoreline Healthcare Technologies we provide personalized support tailored to the unique needs of Massachusetts providers. Our team of experts understands the intricacies of the MassHealth billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Massachusetts

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Specialized Services tailored to meet MassHealth rules and regulations

🩺 Services 📍 Massachusetts Specialization 📈 Typical Improvement ⏱️ Turnaround Time
Medicaid Billing (MassHealth) Integration with the MassHealth Provider Online Service Center (POSC), virtual assistants for real-time eligibility verification Advanced claim-scrubbing tools and compliance with EOHHS. +35% Faster reimbursements, clean claims and reduced rejections. 1-2 weeks
Billing for Managed Care Plans and ACO Programs Expertise in billing for MassHealth Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs) under Payment & Care Delivery Innovation (PCDI) models. Automated payer-specific validation and modifier mapping enhance accuracy across plans. +20% increase in revenue through cross-payer optimization. 24-48 Hours
Denial Management AI based tools to track and flag denial codes and root-cause analysis tailored for MassHealth claim categories, identify high-risk categories and automate resubmissions Reduce rate of denial by 75% and with quicker appeals. 5-7 days
Credentialing & Enrollment Comprehensive provider enrollment and revalidation support with MassHealth, EOHHS, and commercial MCOs including CAQH profile management, MCO credentialing audits Ensures timely reimbursement and eligibility for incentive programs. 45-90 days
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs) Reduces overdue balances and better collection rates. 1-2 weeks
Audit & Compliance Support Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation. Minimizes risk of penalties and supports successful audits. Ongoing, depending on audit schedule

Medical Billing Resources for Massachusetts

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Comprehensive resources specifically designed for Massachusetts Healthcare Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering MassHealth billing requirements, policy updates and compliance standards.

Managed Care program rules and guidelines

Specialized billing guidelines and documentation procedures for managed care programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Massachusetts

Massachusetts’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Massachusetts

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From Barnstable to Worcester, we provide comprehensive medical billing services statewide across all 14 counties of Massachusetts.

Massachusetts Map
Western Massachusetts:

Berkshire, Franklin, Hampshire, Hampden

Central Massachusetts:

Worcester

Eastern Massachusetts:

Middlesex, Essex, Norfolk, Suffolk

Southeastern Massachusetts:

Bristol, Plymouth

Cape Cod & Islands:

Barnstable, Dukes, Nantucket

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Massachusetts

Q1. How can providers check the patient’s eligibility for MassHealth programs?

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Providers can verify the eligibility by

  • ✔ The Provider Online Service Center (POSC) the secure portal of MassHealth.
  • ✔ Call the MassHealth Customer Service Center at 1-800-841-2900
  • ✔ Through the Eligibility Verification System (EVS) integrated within EHR or billing systems
  • ✔ EDI Transaction by Submitting an X12 270/271 Eligibility Inquiry/Response transaction via your clearinghouse or POSC connection.

Q2. What is the claim submission limit for MassHealth claims?

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The timely filing limit for all original claims is 90 days from the date of service. And Secondary Claims that was first submitted to another insurer, can be filed within 90 days from the date of the other payer’s EOB. Whereas for the corrected or adjusted claims the limit is 12 months from the date of service.

Q3. How can providers enroll in MassHealth programs?

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Providers can apply to participate as MassHealth billing entities through

  • ✔ Complete the electronic Provider Enrollment and Credentialing (PEC) application available at the Provider Online Service Center (POSC)
  • ✔ Providers can contact the MassHealth Customer Service Center at 1-800-841-2900 for enrollment support.

All enrolled providers must revalidate their status every five years to maintain their active status as per the EOHHS guidelines.

Q4. What do you mean by Continuous Eligibility (CE)?

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Continuous Eligibility is a policy that allows certain members like children and adults to keep their health coverage stable for a fixed period of 12 months. This means the coverage remains same even if there is any change like an increase in income. It helps to reduce the coverage gaps and provides uninterrupted access to care.

Q5. How can Shoreline Healthcare Technologies help providers in Massachusetts?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Massachusetts Licensed

Licensed to operate in Massachusetts

Medical Billing Glossary

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Essential Terms for Understanding Massachusetts’s Medical Billing Landscape

Executive Office of Health and Human Services (EOHHS)

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It is the state agency of Massachusetts responsible for overseeing all health and human service programs like MassHealth, the Health Connector, and PCDI. They issue regulatory updates, rate changes, and compliance requirements.

Health Connector

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It is health insurance marketplace of Massachusetts created under the Massachusetts Health Care Reform Law offering subsidized and unsubsidized coverage for individuals and small businesses.

MassHealth

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It is a joint funded state and federal government program that covers Medicaid and Children’s Health Insurance Program (CHIP) providing healthcare coverage to low- and moderate-income residents of Massachusetts.

Massachusetts Health Information Highway (Mass HIway)

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The statewide health information exchange (HIE) that allows sharing of patient health information among providers, hospitals, and public health agencies electronically in a secure way.

MyServices

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The portal of MassHealth where members can check and manage their benefits, changes in report, renew the coverage, and track application status.

Payment & Care Delivery Innovation (PCDI)

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It is an initiative of MassHealth Program designed to improve the quality of care and make it cost-efficient through value-based payment models such as Accountable Care Organizations (ACOs) and Community Partners (CPs).

Provider Online Service Center (POSC)

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The secure online portal for providers in Massachusetts where they can verify the eligibility of the members, submit and check the status of the claims, and access their remittance advice.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools – Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Massachusetts understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our massachusett’s-specialized billing services.

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Contact Information

  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Massachusett's billing specialists
  • 24-48 hour claim turnaround
  • Dedicated Massachusetts support team