FAQs: For Providers
Learn About Your New Dental Third-Party Administrator
The Executive Office of Health and Human Services (EOHHS) has contracted with BeneCare Dental Plans (BeneCare) to provide dental third-party administrator (TPA) services for MassHealth, the Children’s Medical Security Plan (CMSP), and the Health Safety Net (HSN).
Frequently Asked Questions (FAQs)
Updated as of August 6, 2025
Claims Submission and Processing
We have identified two main root causes that have created issues in processing claims:
- Provider mapping: MassHealth uses a unique identifier for providers (PID/SL) that can tie to multiple NPIs or Tax IDs. This mapping is complex and needs specific logic in the claims processing system so that claims are affiliated with the right provider and location. Claims processing has been slower than normal as we have worked to ensure this logic and mapping is correct and that payments are being made to the correct provider.
- Multiple lines on a claim: There was an issue with the way that claims were being processed by BeneCare that resulted in only the first line on a claim being read. Claims were coming in but only the first service line was being processed. This resulted in much lower than expected payments on many claims.
These 2 major claims issues have been fixed so that claims are now processing without these issues. Previously incorrectly processed claims had been reprocessed over the month of June. There are some providers whose provider mapping issues are still being resolved.
Additionally, we continue working to identify and resolve other claim processing issues. Currently, we are working to fix claims processing issues due to incorrect eligibility and treatment service history discrepancies. The remediation process for eligibility and treatment history inaccuracies is still being determined.
Starting with the 6/2 claims payments and going forward, weekly claims payments are much closer to normal for more providers due to the major claims fixes (provider mapping and multiple line on claims).
Previously processed claims and claims that previously could not be processed due to providing mapping issues will be remediated, processed, and paid over the month of June. Providers do not need to resubmit claims at this time.
For providers who continue to receive much lower-than-expected claims payments, we continue to work through some provider-specific issues and are reaching out to those providers directly.
If you haven’t already received outreach from the BeneCare team and you either haven’t any claims payment or your payment remains very low, please fill out this form so that we can assist you.
MassHealth will also continue to make interim payment advances to providers who need them upon request over the coming weeks.
BeneCare will be reprocessing claims where only the first line was paid. We anticipate that over the month of June all impacted claims will be remediated and reprocessed for payment. Providers do not need to resubmit claims at this time.
Yes, claims can be sent through the MassHealth Dental electronic payor ID: CKMA1 or (for providers with approved electronic waivers on file with MassHealth) mailed to:
MassHealth Dental Program Claims
c/o BeneCare Dental Plans
P.O. Box 631
Worcester, MA 01613
For details, refer to Section 4.00 “Claim Submission Procedures (Claim Filing Options)” of the Office Reference Manual.
Please attach the primary EOB when submitting the claim.
Claims and prior authorization and optional pre-determination requests have been processing slower than expected due to the claims issues detailed above. As these issues are resolved, this information will be available in the portal.
If the claim or request was submitted online and a reference number was provided after submission, the claim or request has been received. The reference number can be found when selecting the option to print a copy of the claim or request that appears on the confirmation screen after submission. The print option will generate an American Dental Association (ADA) claim form version of the request with a reference number at the top.
We are currently working to fix this error. If a “Procedure Date” is included, it will be processed as a claim. If no “Procedure Date” is included, it will be processed as a prior authorization or optional pre-determination request.
Enter the facility name and address in the Remarks section of the claim.
Telehealth claims should be submitted using the place of service (POS) codes 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home). If submitting the claim through the provider portal, enter the telehealth place of service under Remarks.
MassHealth does not currently use the teledentistry CDT codes D9995 and D9996. Please refer to MassHealth All Provider Bulletin 379 for more details on the MassHealth telehealth policy. The same rules and requirements, including documentation and recordkeeping standards, for covered services that are delivered in-person apply to services delivered by telehealth.
Enter the service location address in the Remarks section of the claim to demonstrate that covered services were provided in one of the five eligible rural counties: Barnstable, Dukes, Berkshire, Franklin, and Hampshire.
Claims missing documentation will be pend and providers will receive written notification about the specific documentation that is needed to process the claim. Letters will be issued in bi-weekly batch transmittals that summarize any claims that are pended for missing documentation and specifies what information is needed.
Providers who batch submit claims through a clearinghouse without electronic
attachments will have any specific claims pend which require additional documentation. Providers then will receive bi-weekly letters listing each of the pended claims and the missing documentation details.
On the provider portal, providers can look up an existing pended claim from the information on the letter and append additional documentation to that claim via the upload function. There is no cost to the provider for this function.
This means that providers can keep their existing electronic clearinghouse claims submission process and add this additional step to submit missing documentation through the provider web portal.
Please note that this additional documentation provider portal function does not allow for editing of a claim in-process. Void, edit, or other change requests will need to be transmitted separately.
In response to provider concerns, MassHealth has suspended until 10/01/2025 pre-payment claim review for crowns and core buildups except for multiple crowns delivered on the same date of service for adults.
The suspension is effective June 12, 2025 and applies to crown and core buildup claims that are appropriately submitted in the period of June 12, 2025 until September 30, 2025.
No; please do not resubmit these claims. HSN claims are currently not being processed due to ongoing eligibility issues. We will provide an update once the issue is resolved.
Please do not resubmit these claims. We are aware that some procedure codes are paying opposite of what they should. This issue is under review. Once the system is updated and the codes are reflecting correctly, we will provide guidance on reprocessing affected claims.
Payments and Rates
The claims issues detailed above have resulted in slower than expected claims
processing timelines. As we resolve these claims issues over the next few weeks, claims payments should go up to normal levels.
MassHealth is offering payment advances for providers who need additional support during this time. To request a payment advance, please fill out this form. Note that payment advances are not recurring, providers must submit a request using the form if they need additional advances.
Providers must submit a separate payment advance request form each week that an advance payment is needed. Payment advance requests cannot be made as an automatic recurring request using a single form.
No, the MassHealth fee schedule remains the same. MassHealth determines the policies, procedures, clinical guidelines, and fees. BeneCare does not set the fee schedule.
Payment methods will remain the same. If payments were received through EFT or check, they will continue in that format. Payment comes directly from the Commonwealth of Massachusetts. BeneCare does not pay claims.
MassHealth has extended the timely filing limit to 180 days through the end of calendar year 2025.
The provider portal does not currently show remittance information. We are actively working on providing remittance advice to providers electronically but in the mean time MassHealth is mailing remittances directly to provider offices.
If your practice has received claims payments but has not received a remittance advice in the mail please reach out to the BeneCare call center or your BeneCare representative.
At this time, 835 files are not available and are not bring provided. We do understand how important this functionality is and electronic 835 files are being considered as part of a future update. BeneCare will provide an update as soon as more information and a timeline for implementation are available.
Provider Portal and Member Information
No, historical information (such as remittance advice and inquiries) is not available. The DentaQuest portal will remain available for read-only access until September 30, 2025. Providers are encouraged to download necessary information as soon as possible.
Please use this direct link to access the historic DentaQuest portal: https://provider.masshealth-dental.net/
Member eligibility verification and service history is available on the new BeneCare provider portal.
When you generate a member Eligibility Report or Treatment History Report, the report will be automatically downloaded to your device. After use, please ensure that you securely store or properly dispose of the file to protect any sensitive information. This report can be saved as proof that eligibility was verified on the date the report was run (i.e. replacing previously required screenshots). Please remember to continue to verify eligibility on the actual date of service.
If you have concerns about the eligibility information in the portal, or are seeing inconsistent information, you can call MassHealth customer service at 800-841-2900 to verify a member’s eligibility.
The provider portal does not currently allow eligibility verification by member name and date of birth. If you need to verify eligibility by member name, you can call MassHealth customer service at 800-841-2900 to check a member’s eligibility.
The provider portal does not currently allow eligibility verification for a date other than the current date on which the report is being run. If you need to verify eligibility for a past or future date, you can call MassHealth customer service at 800-841-2900 to confirm a member’s eligibility on a particular date.
If a member has active TPL coverage, the member eligibility report will include the TPL information. If there is no TPL coverage listed on the member eligibility report, then there is no active TPL coverage on the date that the eligibility report was run.
If you need to verify past or future TPL information, please call 844-MH-DENTL (844-643-3685) to verify by phone.
Please note that the TPL information is not available on the Treatment History Report (this is the version of the report that shows treatment history). This is planned to be added in the future. Currently, the TPL information is only available on the Eligibility Report.
The provider portal now displays the remaining amount of the CMSP $750 annual maximum at the top of the Eligibility Report for CMSP members.
Please note that the CMSP Accumulator is not available on the Treatment History Report (this is the version of the report that shows treatment history). This is planned to be added in the future. Currently, the CMSP Accumulator is only available on the Eligibility Report.
As a reminder, the CMSP benefits, including the $750 annual maximum, are calculated on a state fiscal year basis (starting July 1st and continues through June 30th).
Members who have only CMSP coverage or choose to see a provider who is not a Health Safety Net (HSN) participating provider may have a patient responsibility once the $750 maximum has been reached. Providers may charge the CMSP member up to the MassHealth allowable fee for any service after the annual maximum has been
reached.
$750 – The member has used $0 and their full $750 benefit remains.
$1-$749 – The member has partially used their benefit and the amount displayed is what remains.
$0 – The member has used their full $750 benefit and has NO remaining benefit until the start of the new SFY on July 1, 2025.
TPL and CMSP Accumulator information is not available on the Treatment History Report (this is the version of the report that shows treatment history). This is planned to be added in the future. Currently, the TPL information and CMSP Accumulator is only available on the Eligibility Report.
Yes, multiple members can be verified in one eligibility report using the “Member Eligibility & History” function once logged onto the secure provider portal.
Please note that Treatment History report can only be checked one member at a time. There is not an option to generate the Treatment History report for multiple members.
Prior Authorization and Pre-Payment Review
No, MassHealth prior authorization requirements remain the same. However, there are new requirements to submit supporting documentation with claims for select services. The new documentation submission requirements are part of the pre-payment claim review process.
Pre-payment claim review is a new process to ensure claims align with MassHealth regulations before payment is made. BeneCare will implement pre-payment claim review on behalf of the MassHealth Dental Program.
Pre-payment review includes but is not limited to:
- Member eligibility determination
- Provider eligibility determination
- Benefit coverage determination and/or coordination of benefit
- Determination that the service is medically necessary and meets the applicable standards of care and is not duplicative of another service
When clinical review is needed for pre-payment claim review, documentation must be submitted with the claim.
No, pre-payment claim review is not prior authorization. Providers do not need approval before rendering services. However, providers have the option to request predetermination before treatment.
BeneCare has been experiencing a backlog in processing service authorization requests due to the claims issues detailed above.PA determinations are available on the portal under “Claims Status” and PA determination letters are being mailed out.
For PA requests submitted on or after June 23, providers can expect normal PA turnaround times:
- An average of no more than 5 business days, and
- No more than 21 calendar days for any individual request.
Previously, providers maintained the required documentation in patient records and submitted documentation only when requested. While required documentation and clinical criteria remain unchanged, certain services will now require documentation to be submitted with the claim if subject to clinical pre-payment review.
Providers can choose to submit claim review documentation before OR after providing a service:
- Before treatment: To request an optional pre-determination review, ensuring the proposed treatment meets coverage guidelines.
- With the claim: To verify compliance with MassHealth regulations, coverage policies, and clinical guidelines.
Pre-determination requests can be submitted on the provider portal using the “PA Upload” function. Required documentation is submitted as an attachment.
After submission, a confirmation screen will show “Your request has been submitted successfully.”
Selecting the “click here” option to print a copy of the request will generate an ADA claim form version of the request with a Reference number at the top. This copy of the request and Reference number can be saved for your records.
Please note that it takes about 24-48 hours for the request to process in the system and become searchable using the “Claim Status” function.
Please note that the “Claim Upload” and “PA Upload” portal functions use the same interface. If a date of service is entered, the submission is considered a claim. If no date of service is entered, it is considered a prior authorization or pre-determination request.
Please do not submit a claim and prior authorization/pre-determination request together, they should be submitted separately.
In response to provider concerns, MassHealth has suspended until 10/01/2025 prepayment claim review for crowns and core buildups except for multiple crowns delivered on the same date of service for adults.
The suspension is effective June 12, 2025 and applies to crown and core buildup claims that are appropriately submitted in the period of June 12, 2025 until September 30, 2025.
Please do not resubmit these claims. HSN claims are currently not being processed due to ongoing eligibility issues. We will provide an update once the issues are resolved.
Please do not resubmit these claims. We are aware that some procedure codes are paying opposite of what they should. This issue is under review. Once the system is updated and the codes are reflecting correctly, we will provide guidance on reprocessing affected claims.
- Effective for dates of service April 1, 2025 or after: Permanent lab-processed crowns delivered to adults when more than one crown is delivered on the date of service.
- Effective for dates of service October 1, 2025 or after, for all crowns and core buildups. Additionally, general dentists must submit documentation for:
- Prefabricated crowns;
- Pulpotomies and root canal treatment;
- Partial and complete dentures;
- Surgical tooth extractions and soft tissue and partial bony impaction removals.
BeneCare conducts claim reviews on behalf of the MassHealth Dental Program. All claim reviews are conducted by Massachusetts-licensed dentist consultants in accordance with MassHealth regulations.
- Effective for dates of service April 1, 2025 or after: Permanent lab-processed crowns delivered to adults when more than one crown is delivered on the same date of service.
- Effective for dates of service October 1, 2025 or after for all crowns and core buildups. Additionally general dentists must submit documentation for:
- Prefabricated crowns
- Pulpotomies and root canal treatment
- Partial and complete dentures
- Surgical tooth extractions and impaction removals
For details, refer to Section 6.00 “Documentation Requirements” of the Office Reference Manual.
For more information, please refer to Section 5.00 “Claim Review” of the Office Reference Manual.
Retrospective review after treatment may be considered for all services requiring prior authorization, except orthodontics.
Yes, please complete the HLD form and submit all supporting documentation. The HLD form can be found on Mass.gov or in the ORM on our website. For details, refer to Section 17.00 “Orthodontic Treatment” of the Office Reference Manual.
No, post-treatment and intra-treatment radiographs are considered inclusive in the fee paid for service procedure and are not separately billable. For example, a postcementation radiograph of a crown to confirm margins and check for cement cannot be separately billed as the post-treatment radiograph is inclusive in the fee paid for the crown and is not eligible for additional compensation.
DentaQuest-issued prior authorization (PA) approvals will be honored until their expiration date. The DentaQuest PA# must be submitted with the claim (include in the Remarks section). However, DentaQuest-issued PA decisions will not be available on the BeneCare provider portal. Please refer to the DentaQuest provider portal for
DentaQuest-issued PA decisions.
Please email a list of the affected PA requests to ProviderRequests@massdhp.com. Our claims team will review and advise on the appropriate next steps.
The portal is accurate. You can take a screenshot of the portal approval to use while waiting for the letter.
PA decision letters are mailed 1-3 business days after the decision status appears in the portal. If you haven’t received the letter after more than a week, please contact us via email at ProviderRequests@massdhp.org or call 844-MH-DENTL (844-643-3685)
When we receive a submission without a date of service, it is processed as a prior authorization or optional predetermination request.
We have received reports of claims missing dates of service. Early investigation indicates that a clearinghouse transmission issue has prevented the date of service from being sent for some claims. Early examples have been related to DentalXChange.
With the exception of orthodontic treatment and behavior management, service authorization approvals are valid for 1 year from the issue date (this is the “Prepared” date on the first page of the letter). Authorization for orthodontic treatment and behavior management is valid for 36 months from the date of approval.
The portal is accurate. You can take a screenshot of the portal approval to use while waiting for the letter.
PA decision letters are mailed 1-3 business days after the decision status appears in the portal. If you haven’t received the letter after more than a week, please contact us via email at ProviderRequests@massdhp.org or call 844-MH-DENTL (844-643-3685).
Other Questions
You do not need to credential with BeneCare if you are already credentialed with MassHealth. Your credentialing status does not change.
Your credentialing effective date and current recredentialing dates remains the same and are not changing.
For new enrollment and credentialing, please email providerrelations@massdhp.com for assistance.
For recredentialing, existing providers will receive information based on their existing recredentialing dates.
During the transition process, we have identified some provider data that needs to be corrected in our MassHealth Medicaid Management Information System (MMIS) system. These may be due to a previous TIN change or a long overdue revalidation. The BeneCare Provider Relations team will reach out to you if you need to complete new enrollment forms.
For more information:
- Visit massdhp.org
- Call 844-MH-DENTL (844-643-3685)
- Email: ProviderRequests@massdhp.org
Please see below to find the provider representative who is assigned to your county:
Melissa Overton, melissa.overton@massdhp.com, 774.425.7694: Barnstable County, Bristol County, Dukes County, Nantucket County, Plymouth County, and Suffolk County.
Nataly Santos, nataly.santos@massdhp.com, 508.972.0028: Upper Berkshire County*, Franklin County, Middlesex County, and Norfolk County.
Brianna Jones, brianna.jones@massdhp.com, 774.351.2718: Lower Berkshire County**, Essex County, Hampden County, Hampshire County, and Worcester County.
* – Towns in upper Berkshire County: Adams, Cheshire, Clarksburg, Dalton, Florida, Hancock, Hinsdale, Lanesbourough, New Ashford, North Adams, Peru, Pittsfield, Savoy, Williamstown, and Windsor
** – Towns in lower Berkshire County: Alford, Becket, Egremont, Great Barrington, Lee, Lenox, Monterey, Mount Washington, New Marlbourough, Otis, Richmond, Sandisfield, Sheffield, Stockbridge, Tyringham, Washington, and West Stockbridge
If there are additional questions you do not see in this FAQ, please send them to MassHealth using this form.