The MassHealth Card

The MassHealth card identifies a person as being a MassHealth member. However, it does not guarantee that the cardholder is eligible for the specific date or date range of service, or that MassHealth will pay for the services. Therefore, the provider should request to see the card and must access the eligibility verification system (EVS) to verify eligibility for a specific date or range of dates.

Verifying Eligibility

 EVS provides you with eligibility information for all MassHealth members. By verifying a member’s eligibility on the day or date range of service, you may be able to reduce the risk of your claims being denied. 

All providers are required to have a user ID and password to use EVS. To obtain a user ID and password, each provider must sign a MassHealth Trading Partner Agreement (TPA).  

Providers without Internet access can call the automated voice response (AVR) system at 1-800-554-0042 or call the eligibility operator at 1-800-841-2900. Contact information for MassHealth Customer Service appears in Appendix A of your provider manual. Active EVS codes and their respective service restriction messages are available in Appendix Y of your provider manual. You may also refer to the EVS User Guide for more information about these and other access methods.

Security and Privacy 

Your current MassHealth provider agreement, in combination with the TPA, requires you to make every effort to secure and protect information transmitted to and from our system. The HIPAA Privacy Rule (45 CFR Part 164.500, et seq.) governs uses and disclosures of protected health information. MassHealth’s Data Protection Policies and Procedures contain information on workforce compliance with state and federal confidentiality laws for reference.