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Massachusetts Medicaid

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Massachusetts Medicaid

Overview

State Medicaid program. Theoria-side enrollments transitioning to Complex Care Medical Group billing entity (effective 2026-04-01) — distinct from the Complex Care Solutions customer.

Active Work / Processes

  • Anna Kavitt — partially completed; in flight.
  • Chidi — Theoria-side stopped (transitioning to complex care Midwest M effective 4/1); needs re-check on FFS-vs-ORP eligibility (may have prescribe-only / order-only ability).
  • Ola/Olam — Latoya’s original submission used completely wrong values (complex care + Midwest M + Dr. Drew Packy); being redone via direct payer-contact (Bernadette).

Pain Points / Open Issues

  • Group enrollment requires fee-for-service providers (not ORP) — Chidi may be ineligible at group level if he lacks FFS.
  • Facility-contract path allows ORP — alternate route when group enrollment isn’t open to a provider.
  • Ola/Olam misfiling by departed teammate (Latoya) — required a full redo direct with payer.

Decisions & Commitments

  • 2026-04-17 — Theoria-side stopped for Chidi (transitioning to complex care Midwest M effective 4/1). Source: Svetlana + Amy in 17 weekly sync.

Key Facts

  • Group enrollment requirement: providers must be fee-for-service (not ORP)
  • Facility-contract alternate: providers can be ORP or FFS under a facility contract
  • Direct payer contact: Bernadette (Ola/Olam redo channel)
  • Theoria Medical — Chidi stopped Theoria-side; Anna Kavitt in flight; Ola/Olam being redone

Source History

  • 2026-04-15 — Complex weekly sync — FFS-vs-ORP rule, Latoya wrong-value submission for Ola/Olam
  • 2026-04-17 — Theoria weekly sync — Chidi Theoria-side stop, complex-care 4/1 effective transition

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