Medical Billing Terms M: MassHealth Medicaid Billing and Managed Care Terms

MassHealth Medicaid billing follows the rules of the Massachusetts Medicaid program. This page defines MassHealth with the Medicaid terms from MAC jurisdiction to Medicaid rehabilitation option, including Medicaid MCO, carve-out, expansion and MBHO. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms M: MassHealth Medicaid - MCM South Medical Billing Service, LLC

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On this page (21 terms)

MAC Jurisdiction
Machine Learning in Revenue Cycle
MACRA
Magellan Health
Malpractice Insurance (Professional Liability)
Managed Behavioral Health Organization (MBHO)
Marketplace Plan
Marriage and Family Therapist (Medicare)
MassHealth
Measurement-Based Care
Measurement-Based Care (Joint Commission)
Medicaid
Medicaid Carve-Out
Medicaid Expansion
Medicaid Fee Schedule
Medicaid HCPCS Code
Medicaid Health Home
Medicaid ID
Medicaid Managed Care Organization (MCO)
Medicaid Redetermination
Medicaid Rehabilitation Option

How to use these MassHealth Medicaid definitions

Use this page as a quick reference for MassHealth Billing, from MAC Jurisdiction to Medicaid Rehabilitation Option. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm MassHealth Billing details with the payer before you bill.

Checklist: put the masshealth medicaid definitions to work

Check the masshealth medicaid entries above before you send a claim that depends on them.
Share this masshealth medicaid page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions masshealth medicaid, find the matching entry and note the date you checked it.
Keep your masshealth medicaid notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies masshealth medicaid before you change a workflow.
Train new staff on masshealth medicaid first, then move on to the rest of the glossary.
Log any masshealth medicaid question that comes up twice, then add the answer to your billing procedures.
Use the source links under the masshealth medicaid entries to confirm the current rule.
Print the masshealth medicaid entries you use most and keep them at the billing desk.
Review your masshealth medicaid notes each quarter, because payer and CMS rules change.
Mark where masshealth medicaid work differently for psychotherapists and for psychiatrists in your own procedures.
If a masshealth medicaid entry does not match what your payer tells you, follow the payer contract and ask for the answer in writing.
A common masshealth medicaid mistake is relying on an old payer bulletin, so check the date on every source.
Another masshealth medicaid mistake is copying a definition into a policy without citing the source.
Send questions about masshealth medicaid to one billing lead so the answer is shared once.
For masshealth medicaid that affect payment, record the claim number and the name of the payer representative.

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MAC Jurisdiction

Medicare

Also called Medicare jurisdiction; MAC region; Part B MAC jurisdiction

Definition: A MAC jurisdiction is the geographic area served by one Medicare Administrative Contractor. Each MAC processes claims and issues local rules for the providers in its area.
Why it matters: Which MAC you bill, and its local coverage rules, depend on where you practice. If you bill in more than one state, you may deal with more than one MAC.
Illustrative example: A practice in two states finds that each state is under a different MAC with different local articles.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Credentialing & Enrollment

Machine Learning in Revenue Cycle

General (all payers)

Also called predictive denial modeling; AI denial prediction

Definition: Using statistical models to predict outcomes such as denials, and prioritize work.
Why it matters: Can highlight risky claims before submission.
Illustrative example: A model flags claims likely to deny.

Related termsDenial Management Automation

Reference sourceHFMAchecked 10/9/26

CategoriesAI & Healthcare Automation Terms Revenue Cycle Metrics

MACRA

General (all payers)

Also called Medicare Access and CHIP Reauthorization Act

Definition: A federal law that created the Quality Payment Program, replacing the older Medicare payment update formula with MIPS and advanced APM tracks.
Why it matters: Explains why some Medicare clinicians report quality data.
Illustrative example: A clinician reports to MIPS under MACRA rules.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Quality Payment Programchecked 10/9/26

CategoriesValue-Based Care Terminology Quality & Risk Adjustment Terms

Magellan Health

Private payer

Also called Magellan Healthcare; eMbrace

Definition: A behavioral health company now part of Centene that manages behavioral health benefits and some EAP services.
Why it matters: A provider may be credentialed with it for certain plans or EAPs.
Illustrative example: A provider joins Magellan's network for an EAP.

Reference sourceMagellan Healthchecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms Behavioral Health Specific Terms

Malpractice Insurance (Professional Liability)

General (all payers)

Also called professional liability insurance; malpractice coverage

Definition: Insurance covering claims of professional negligence. Payers require proof of coverage limits during credentialing.
Why it matters: An expired certificate can pause a credentialing file.
Illustrative example: The practice uploads a current certificate of insurance to the CAQH profile.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment

Managed Behavioral Health Organization (MBHO)

General (all payers)

Also called MBHO; behavioral health administrator; BHO

Definition: A company that administers behavioral health benefits for health plans, including networks, utilization review, and claims.
Why it matters: Explains why some behavioral health claims go to a different company than the medical plan.
Illustrative example: A therapist is credentialed with the MBHO, not with the medical plan.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms BCBS, UHC & Commercial Payer Terms

Marketplace Plan

General (all payers)

Also called ACA plan; exchange plan; individual plan

Definition: An individual or small-group health plan bought through a federal or state health insurance marketplace under the Affordable Care Act.
Why it matters: Marketplace plans have grace periods, metal tiers, and network limits that affect claims.
Illustrative example: A patient buys a silver plan on the exchange.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms Eligibility & Benefits

Marriage and Family Therapist (Medicare)

Medicare

Also called MFT Medicare; LMFT Medicare enrollment; Medicare marriage and family therapist

Definition: For Medicare, a marriage and family therapist generally needs a master's or doctoral degree and at least two years or 3,000 hours of post-master's clinical supervised experience, plus state licensure or certification. CMS lists MFTs among the practitioners who can bill Medicare for mental health services.
Why it matters: MFTs became eligible to enroll in Medicare as a provider type. Check current enrollment requirements and the services covered before billing.
Illustrative example: An LMFT confirms the degree, hours, and license and enrolls in Medicare as an MFT.

Reference sourceCMS Medicare Learning Network (MLN)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Credentialing & Enrollment

MassHealth

Medicaid (state-specific)

Also called Massachusetts Medicaid

Definition: The name of Massachusetts' Medicaid and CHIP program, which includes managed care options and behavioral health arrangements.
Why it matters: Massachusetts is a served state; MassHealth rules are separate from other states.
Illustrative example: A Massachusetts provider enrolls with MassHealth and contracts with plans.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms

Measurement-Based Care

General (all payers)

Also called MBC; outcome measures; PHQ-9 tracking

Definition: Routinely using standardized symptom measures during treatment to guide decisions and track progress.
Why it matters: Increasingly requested by payers and required in some value-based contracts.
Illustrative example: A therapist records PHQ-9 scores at each visit.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesQuality & Risk Adjustment Terms Behavioral Health Specific Terms

Measurement-Based Care (Joint Commission)

General (all payers)

Also called Joint Commission measurement-based care standard; CTS.03.01.09; standardized tool progress monitoring

Definition: The Joint Commission's measurement-based care standard for behavioral health requires accredited organizations to use standardized tools to monitor a person's progress and to use the results to inform care.
Why it matters: It links clinical practice and quality, and can link to billing through screening codes such as 96127. Ask your accreditor for the current requirement.
Illustrative example: An accredited clinic gives the PHQ-9 at intake and at set intervals and reviews scores with the client.

Reference sourceThe Joint Commissionchecked 10/9/26

CategoriesQuality & Risk Adjustment Terms Behavioral Health Specific Terms

Medicaid

Medicaid (state-specific)

Also called state Medicaid program; Medicaid billing

Definition: A joint federal and state program that provides health coverage to eligible low-income people, with rules that vary by state.
Why it matters: Medicaid is state-specific: covered services, codes, rates, and managed care plans differ.
Illustrative example: A state Medicaid program covers home-based therapy that another state does not.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms

Medicaid Carve-Out

Medicaid (state-specific)

Also called behavioral health carve-out (Medicaid); carved-out benefits

Definition: An arrangement where a state delivers certain benefits, often behavioral health, outside the main managed care plans, through a separate entity or fee-for-service.
Why it matters: Claims may go to a different payer than the member's medical plan.
Illustrative example: A member's physical health is in one MCO but behavioral health is handled by a separate entity.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Medicaid Expansion

Medicaid (state-specific)

Also called expansion adult group; Medicaid expansion states; ACA Medicaid expansion

Definition: Medicaid expansion is the option under the Affordable Care Act for states to cover adults with incomes up to a set share of the federal poverty level. States decide whether to adopt it.
Why it matters: It changes who is covered in a state and can shape the payer mix of a behavioral health practice. Confirm whether your state expanded Medicaid.
Illustrative example: A practice serving both an expansion state and a non-expansion state sees different Medicaid eligibility patterns.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Eligibility & Benefits

Medicaid Fee Schedule

Medicaid (state-specific)

Also called state Medicaid fee schedule; Medicaid rates; Medicaid reimbursement rates

Definition: A Medicaid fee schedule is the list of rates a state Medicaid program or a Medicaid managed care plan pays for covered codes. States publish their own.
Why it matters: Medicaid rates can differ widely by state and plan. Check the state or plan schedule, not Medicare, before you predict payment.
Illustrative example: A practice checks the state's published fee schedule for a psychotherapy code before accepting Medicaid patients.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement Medicare & Medicaid Terms

Medicaid HCPCS Code

General (all payers)

Also called H-code; T-code; Medicaid behavioral health code

Definition: A HCPCS Level II code that a state Medicaid program uses for behavioral health services, such as community support or psychosocial rehabilitation. Definitions and rates vary by state.
Why it matters: Codes and their meaning are state-defined and must be checked in the state manual.
Illustrative example: A state's Medicaid manual lists an H-code and units.

Reference sourceMedicaid.gov CMS HCPCSchecked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Medicaid Health Home

Medicaid (state-specific)

Also called health home; Section 1945 health home; Medicaid health home program

Definition: A Medicaid health home is a state plan option under which a state can pay for coordinated care for people with certain chronic conditions, which can include serious mental illness and substance use disorders.
Why it matters: States design their own programs, so eligibility, providers, and payment differ. Providers may need to enroll separately.
Illustrative example: A state's health home program pays a clinic for care coordination for enrollees with serious mental illness.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Medicaid ID

General (all payers)

Also called Medicaid provider ID; Medicaid billing number

Definition: The identifier a state Medicaid program assigns to an enrolled provider for billing.
Why it matters: Claims to Medicaid or its plans need the correct provider ID or NPI as the state requires.
Illustrative example: A state requires a Medicaid ID on claims in addition to the NPI.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesProvider Data Management Terms Medicare & Medicaid Terms

Medicaid Managed Care Organization (MCO)

Private payer

Also called MCO; Medicaid managed care plan; managed Medicaid

Definition: A private health plan that contracts with a state to deliver Medicaid benefits to enrolled members for a capitated payment.
Why it matters: Providers must contract with each MCO separately, and each has its own portal, authorization, and rules.
Illustrative example: A therapist is enrolled with the state and separately credentialed with three MCOs.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms BCBS, UHC & Commercial Payer Terms

Medicaid Redetermination

Medicaid (state-specific)

Also called Medicaid renewal; eligibility redetermination; Medicaid unwinding

Definition: A Medicaid redetermination, also called a renewal, is a state review to decide whether a person still qualifies for Medicaid. States must do it regularly.
Why it matters: Patients can lose coverage after a renewal, so verify eligibility before each visit and watch for retroactive changes.
Illustrative example: A patient's Medicaid ends after a renewal, and the biller finds out during an eligibility check.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Eligibility & Benefits

Medicaid Rehabilitation Option

Medicaid (state-specific)

Also called rehab option; Medicaid rehabilitative services; mental health rehabilitation

Definition: The Medicaid rehabilitation option is a state plan benefit that lets a state cover rehabilitative services, which many states use for community-based mental health services.
Why it matters: The services and provider types differ by state. Check the state manual for codes and rules.
Illustrative example: A community provider bills a state's rehabilitation benefit for skill-building services.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms Medicare & Medicaid Terms

Quick answer: MassHealth Medicaid

What is MassHealth?

MassHealth is the name of Massachusetts' Medicaid and CHIP program, which includes managed care options and behavioral health arrangements. Massachusetts is a served state; MassHealth rules are separate from other states.

Frequently asked questions: MassHealth Medicaid

What is Medicaid?

Medicaid is a joint federal and state program that provides health coverage to eligible low-income people, with rules that vary by state. Medicaid is state-specific: covered services, codes, rates, and managed care plans differ.

What is a Medicaid managed care organization (MCO)?

Medicaid Managed Care Organization (MCO) is a private health plan that contracts with a state to deliver Medicaid benefits to enrolled members for a capitated payment. Providers must contract with each MCO separately, and each has its own portal, authorization, and rules.

What is a managed behavioral health organization (MBHO)?

Managed Behavioral Health Organization (MBHO) is a company that administers behavioral health benefits for health plans, including networks, utilization review, and claims. Explains why some behavioral health claims go to a different company than the medical plan.

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Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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