- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Stream RCM is committed to serving all physician groups, hospitals, and specialty practices throughout Massachusetts as a dependable and professional medical billing company that Massachusetts healthcare providers can rely upon for precise medical billing and quicker reimbursements. We know what it takes to meet MassHealth regulations, commercial payer rules, and the requirements of Massachusetts compliance laws.
Denials Drain Revenue
Providers in Massachusetts run three MassHealth Accountable Care Organization programs, changing the timeline for prior authorizations, as well as frequent changes of hospital ownership due to recent changes in Steward Health Care. Strong privacy regulations enforced by Massachusetts General Law Chapter 93H and Patients First disclosure regulations put extra pressure on them. Incorrect coding, authorization failures, and obsolete eligibility verification result in delayed payments.
Average Claim Denials
Slower Payer Reimbursements
Revenue Lost Annually
We serve a wide range of specialties throughout Massachusetts, including primary care, pediatrics, behavioral health, cardiology, orthopedics, and oncology. Our medical billing and coding Massachusetts specialists understand documentation standards tied to the MassHealth Section 1115 Waiver behavioral health services, including residential substance use treatment and medication assisted treatment programs. We also assist in managing referrals for home health care, physiotherapy, and multi-specialty group practices under the Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim, Tufts Health Plan, and Fallon Health payers. Each specialty is provided with coding and billing assistance as per their respective payer guidelines.
We combine Massachusetts payer expertise with proven billing accuracy, transparent reporting, and dedicated account management. Practices gain a partner that understands MassHealth complexity, commercial payer variation, and the compliance demand unique to healthcare providers operating throughout the Commonwealth.
Stream RCM follows an organized revenue cycle process designed around Massachusetts payer rules and MassHealth ACO requirements. Every claim moves through verification, coding, submission, and follow up stages to protect accuracy and speed reimbursement for practices statewide.
Patient Eligibility Verification
Prior Authorization CheckAccurate Medical Coding
Charge Entry Review
Claims Scrubbing Process
Electronic Claims Submission
Payment Posting
Denial Management Appeals
Monthly ReportingAll services are first checked by our team to ensure that patients have valid insurance under MassHealth, MassHealth ACOs, Primary Care Clinician Plan, Medicare, and commercial insurance plans such as Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim, Tufts Health Plan, and Fallon Health. This process is used to ensure that the coverage is valid, the patient is assigned the proper model A, B, or C under ACO, and what the patients owe in copays. If Massachusetts providers submit claims using old eligibility information, they miss out on money, which is why our process is in place.
One of the most frequent reasons for denials in Massachusetts relates to prior authorization delays. We maintain information regarding prior authorization requirements related to outpatient, specialty, imaging, behavioral health programs, and therapy visits. Beginning from January 2026, MassHealth is obligated to process prior authorization requests of medical benefits within seven days and expedited prior authorizations within seventy-two hours. We monitor these deadlines carefully, make requests in advance, and take proactive measures to avoid delay in treatment and claim denials due to lack or expiration of required authorization documents.
Accurate ICD 10, CPT, and HCPCS codes will be assigned for each and every patient visit according to coding guidelines applicable to payers of Massachusetts. This would include proper use of modifiers, meeting medical necessity, and appropriate level of detail for each visit as per MassHealth Regulation 130 CMR 450.000. Special attention is given to behavioral health, pediatrics, and specialty claims due to the high-level of documentation involved. The accuracy of coding at this stage would minimize any denial in the later stages and protect physicians from payer audits.
Each charge is analyzed prior to submission to ensure proper services rendered, dates, providers, and coding according to the clinical documentation. The charge analysis detects missing charges, duplicates, and inconsistencies in units that usually lead to payer denials. In order to accommodate for recent changes in the ownership of hospitals by Steward Health Care in Massachusetts, our staff verifies current billing entity information and the identifier of the person submitting the claim. Effective charge analysis at this point saves on resubmissions and ensures a smooth process of account receivable turnover.
Prior to submission, all claims go through a process of scrubbing in order to identify any coding problems, lack of modifiers, incorrect identifiers, and payer-specific formatting issues. Different commercial payers from Massachusetts, such as Blue Cross Blue Shield of Massachusetts, Point32Health, and others, have their own specific criteria for submissions, which need to be followed accurately. The scrubbing process also ensures that MassHealth ACO attribution and routing are accurate prior to claim submission. Such a process decreases the risk of first-pass rejections significantly.
Claims that have been processed are then transmitted electronically to the appropriate channel of the payer, which could be MassHealth Fee for Service, any of the MassHealth ACO models, Primary Care Clinician Plan, Medicare, or any commercial insurer in Massachusetts. It is important to remember that timely submission of claims is one of the main reasons why claims may be denied, and our staff monitors the deadlines for submission of claims to each specific payer and electronically confirms their receipt.
In case payments come in from MassHealth, Medicare, or insurance companies, our posting will be made accurately per claim reconciling any discrepancies between the bill amount and the payment received. We make sure that any under-payments, wrong adjustments, or any variance issues are investigated immediately rather than being put on hold indefinitely. It becomes extremely important to carry out a reconciliation process for Massachusetts practices that run more than one MassHealth ACO model together at the same time, given that the logic of payments could be different for Models A, B, and C.
In case of claim denial, we investigate into the reason for claim denial, whether it may be due to lack of authorizations or any coding or eligibility related issue and resubmit a corrected appeal before the deadline set by the payer. Denial rates at the first attempt have been observed to be high in the state of Massachusetts due to issues related to MassHealth documentation guidelines and changes in policies of commercial payers. Our process involves identifying and addressing the causes of reoccurring denials through our billing cycle.
Every month, practices are provided with a well-defined report that covers claim submissions, payments, denial trends, and receivables that have yet to be paid. The report focuses on the performance of each payer, specifically Massachusetts Health ACO model, Medicare, and Massachusetts Commercial payers, to ensure that the practice owner knows exactly how revenue comes in and where delays can be anticipated. Our reports are not simply numbers with no explanation; they give you an understanding of why these things happen, making them very useful for financial planning.
Most of the medical billing companies in Massachusetts consider whether they should handle their billing in-house or choose to outsource it to one of the existing medical billing agencies in Massachusetts that they can use. An in-house team provides better control but has problems handling the complexity of MassHealth ACOs, employee turnover, and increasing staffing costs. Outsourcing will provide more experienced people who will help with payers and denials.
| Factor | In House Billing | Outsourced Billing with Stream RCM |
|---|---|---|
| MassHealth ACO Expertise | Limited to internal staff knowledge. | Dedicated specialists across Model A, B, and C. |
| Staffing and Turnover | Ongoing hiring and training burden. | Stable, experienced team with no turnover risk. |
| Denial Management Speed | Often delayed due to workload. | Prioritized daily with structured appeal tracking. |
| Cost Structure | Fixed salaries, benefits, and overhead. | Predictable, performance aligned cost model. |
| Scalability | Difficult to scale during growth. | Adjusts easily as patient volume changes. |
Stream RCM offers a full range of billing solutions built specifically for Massachusetts practices, from small clinics to hospital systems.
Our team submits clean, accurate claims to MassHealth, Medicare, and Massachusetts commercial payers daily that minimize rejection rates and accelerate practice revenue.
We investigate every denial thoroughly, correct underlying errors, and resubmit appeals promptly, recovering revenue that Massachusetts practices would otherwise lose to payers.
We manage provider credentialing across MassHealth, Blue Cross Blue Shield, and other Massachusetts payers, minimize enrollment delays that postpone reimbursement significantly.
Our team pursues aging accounts receivable, working directly with MassHealth and commercial payers to resolve outstanding balances before they become unrecoverable and uncovered.
We keep Massachusetts practices aligned with state privacy laws and MassHealth regulations, delivering transparent monthly reports covering claims, denials, collections and revenue.
We work with physician offices all over the state of Massachusetts from Boston area hospitals down to the rural communities in Berkshire, Cape Cod and the Islands.
The billing process for Suffolk County facilities, including prominent Boston teaching hospitals, and gets individual assistance for bills.
Middlesex County-based vendors can take advantage of improved billing processes for highly multispecialty physician groups.
Umass Memorial affiliated providers, PCPs, and rural health centers dealing with eligibility changes among their MassHealth patients.
Providers in Essex County receive uniform billing services from coastal community hospitals, urgent care centers, and programs.
Norfolk County practices receive focused revenue cycle support for suburban primary care groups, specialty, and all practices.
Bristol County providers, including practices near Fall River and New Bedford, managing MassHealth Medicaid enrollment.
Plymouth County practices benefit from dedicated billing support covering primary care, orthopedics, and growing senior care.
Hampden County providers, including Springfield area practices, receive support managing Baystate Health affiliated billing needs.
In Hampshire County, where billing is associated with the practices of academic medical centers, behavioral health, and pediatrics services.
The Franklin County providers who serve the rural areas of western Massachusetts get special assistance when handling problems.
Practices in Berkshire County have specific assistance for rural health care delivery, telemedicine billing, and MassHealth enrollment.
Barnstable County practices across Cape Cod receive seasonal patient volume support and tourism related billing fluctuations.
Dukes County providers on Martha's Vineyard receive specialized support managing seasonal staffing, limited local resources, and challenges.
Nantucket County practices benefit from remote billing support that address island specific staffing and seasonal population shifts.
Greater Boston practices, spanning multiple counties and academic medical centers, receive comprehensive support for the complex.
We help Massachusetts practices reduce denial rates, accelerate reimbursement timelines, and strengthen overall revenue cycle performance through consistent, payer specific billing management.
Yes. We manage billing across MassHealth Model A Partnership, Model B Direct, and Model C Managed Care Organization structures, applying correct attribution rules, referral requirements, and payer specific documentation standards for each individual ACO arrangement.
Our team tracks current hospital ownership changes closely, updating credentialing profiles, submitter identifiers, and billing entity information promptly so claims route correctly and reimbursement is not delayed by outdated transition related records.
Yes. We work with solo practitioners, multi specialty groups, and hospital affiliated practices throughout Massachusetts, scaling our billing support to match each practice size, specialty mix, and specific payer relationships involved.
These are processed by Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim, Tufts Health Plan, Fallon Health, United Healthcare, Aetna, and Cigna. The processing is done according to the specific modifier codes, documentation, and pre-authorization of these firms.
Denials are processed soon after being received, with corrections to the claim or appeal filed according to each payers’ deadline. We also monitor common reasons for denials based on each payer and the type of service.
Yes. We manage credentialing and enrollment across MassHealth, commercial carriers, and hospital networks, tracking renewal deadlines and application status closely to prevent enrollment gaps that could delay provider reimbursement unexpectedly.
Partner with a righthand medical billing company in Massachusetts practices rely on for consistent revenue.
