The best medical billing companies in Massachusetts in 2026 are One O Seven RCM, MedHeave Healthcare Services, Billing Advantage, and Medical Healthcare Solutions, based on verified headquarters, published pricing, contract terms, and readiness for MassHealth and 2027 payer rules. We checked every company on its own website on November 5, 2026.
Medical billing in Massachusetts carries rules most states don’t have. MassHealth covered 1,866,686 members as of July 31, 2026, according to the MassHealth July 2026 enrollment snapshot. MassHealth must receive most fee-for-service claims within 90 days of the date of service, and the June 2026 version of 211 CMR 52.00 rewrote commercial prior authorization.
Several published lists place out-of-state firms in Boston, so we checked each headquarters address and grouped Massachusetts-based firms apart from out-of-state ones. Practices in Boston, Worcester, Springfield, and Lowell can use that split to compare medical billing companies in Massachusetts on equal terms.
Key Takeaways
Massachusetts medical billing companies at a glance, as of November 2026:
The ranked picks
- Best overall: One O Seven RCM (Fulshear, TX): 3% of insurance collections, all-inclusive, month-to-month, serving Massachusetts practices from Texas.
- Best published local rate: MedHeave Healthcare Services (Boston): posts 4% to 7% of collections and a 30-day termination notice.
- Best for mental health practices: Billing Advantage (Amesbury): started inside a psychotherapy practice in 2004 and posts 5% to 7% of collections.
- Best for specialty groups: Medical Healthcare Solutions (Andover): billing since April 1991, with orthopedics, gastroenterology, and student health on its list.
- Best for named Massachusetts payers: Emerald Health (Dartmouth): its site names BCBSMA, Harvard Pilgrim, Tufts, and MassHealth experience.
- Best for ambulance and EMS: New England Medical Billing (South Easton): billing since 1993, including school-based Medicaid claiming.
Massachusetts facts to know
- Out-of-state clarity: Boston Billing Solutions (Londonderry, NH): headquartered in New Hampshire despite the Boston name.
- Deadline: MassHealth must receive fee-for-service claims within 90 days of the date of service, a window all medical billing companies in Massachusetts track.
- 2027 watch item: Patients First Act price transparency provisions take effect January 1, 2027, with penalties of up to $2,500 per instance.
In This Guide
Medical Billing Companies in Massachusetts Compared at a Glance
This list of medical billing companies in Massachusetts compares each firm on verified headquarters and on whether it publishes its price, a defined performance metric, and its exit terms. “Not published” means we couldn’t find the item on the company’s own website on November 5, 2026.
Table 1. Verified November 5, 2026. Sources: company websites and BBB records.
| # | Company | Headquarters (verified) | Massachusetts-based | Published price | Published performance metric | Published exit terms | Best for |
|---|---|---|---|---|---|---|---|
| 1 | One O Seven RCM | Fulshear, TX | No (serves MA remotely) | 3% of insurance collections | 98.7% first-pass acceptance (company-reported) | Month-to-month, 30-day notice | Full RCM at one published price |
| 2 | MedHeave Healthcare Services | Boston, MA | Yes | 4% to 7% of collections | Figures listed, not defined | 30 days’ notice | Boston practices wanting a posted rate |
| 3 | Billing Advantage | Amesbury, MA | Yes | 5% to 7% plus startup fee | 98.43%, measured on its own practice | Not published | Mental health and therapy practices |
| 4 | Medical Healthcare Solutions (MHS) | Andover, MA | Yes | Not published | 98.5% clean claims, short definition | Not published | Specialty groups, student health |
| 5 | Emerald Health | Dartmouth, MA | Yes | Not published | Figures inconsistent across pages | No multi-year lock-ins (partial) | Named Massachusetts payer experience |
| 6 | Merrimack Billing Solutions | Andover, MA | Yes | Not published | Not published | Not published | Auto and workers’ comp claims |
| 7 | Analytix Healthcare Solutions | Woburn, MA | Yes | Not published | Not published | Not published | HME and DME suppliers |
| 8 | New England Medical Billing (NEMB) | South Easton, MA | Yes | Not published | Figures listed, not defined | Not published | Ambulance, EMS, school Medicaid |
| 9 | Bradford Medical Associates | North Andover, MA | Yes | Not published | Not published | Not published | Massachusetts and New Hampshire practices |
| 10 | Comprehensive Practice Management | Framingham, MA | Yes | Not published | Not published | Not published | Independent practices wanting CPA oversight |
| 11 | Boston Billing Solutions | Londonderry, NH | No | Not published | Not published | No long-term contracts (partial) | Solo in-network behavioral health |
| 12 | Coronis Health | Jackson, MI | No (MA offices) | Not published | Figures listed, not defined | Not published | Hospitals and health systems |
How We Ranked These Medical Billing Companies in Massachusetts
We ranked the top medical billing companies in Massachusetts on six criteria that predict what a practice will pay and collect. Each criterion is one question you can check on a company’s website before you ever book a sales call.
- Verified headquarters. We confirmed each street address on the company’s own site and separated Massachusetts-based firms from out-of-state ones. Some published lists still place out-of-state firms in Boston or name MassHealth plans that closed on January 1, 2026.
- Published price. We looked for a rate posted on the company’s website, with no form or sales call required.
- Defined performance metric. We counted a metric only when the company stated a number and explained how it measures that number. “High clean-claim rates” didn’t count.
- Written exit terms. We looked for contract length, notice period, and cancellation penalties in writing.
- Service breadth. We checked whether one engagement covers full RCM, including credentialing and prior authorization.
- Massachusetts payer readiness. We looked for published MassHealth, ACO, or Massachusetts commercial payer experience, the evidence that a medical billing company in Massachusetts knows local rules.
We left out paid placements and review star counts, because star totals don’t measure billing performance. Our team read each company’s own website on November 5, 2026, used BBB records for founding dates a site doesn’t state, and will re-check the list every quarter.
We placed One O Seven RCM first because it publishes all three proofs in criteria 2 to 4. It’s the only firm on this list that publishes all three. MedHeave Healthcare Services comes closest, with a posted rate and a notice period but no defined metric.
The list mixes independent medical billing firms with national RCM companies, so you can weigh medical billing experts in Massachusetts against the third-party medical billing companies that serve the state from elsewhere.
The 12 Best Medical Billing Companies in Massachusetts (2026)
One O Seven RCM ranks first among the medical billing companies in Massachusetts we reviewed. Massachusetts-headquartered firms follow, ordered by how many of the three proofs they publish, then by service breadth and years in business. Out-of-state firms come last, so you can scan the local group first.
1. One O Seven RCM: Best Overall for Transparent, All-Inclusive Full RCM
One O Seven RCM is a full-service medical billing and revenue cycle management company headquartered in Fulshear, Texas, that serves Massachusetts practices of every size remotely for a published 3% of insurance collections.
Among medical billing companies in Massachusetts, One O Seven RCM publishes three things most firms keep behind a sales call: an all-inclusive rate, a defined performance metric, and written exit terms. You know what you’ll pay, how we measure ourselves, and how to leave before you sign anything.
One O Seven RCM at a glance, November 2026
| Attribute | Value |
|---|---|
| Headquarters | 27120 Fulshear Bend Dr, Ste #900-11, Fulshear, TX 77441 |
| Serves Massachusetts | Yes, remotely; all 50 states |
| Price | 3% of insurance collections; patient copays and balances aren’t charged |
| Fees | No setup fee, retainer, monthly minimum, or software charge |
| Credentialing | $107 per insurance panel |
| Contract | Month-to-month, 30-day written notice, no cancellation penalties |
| First-pass acceptance | 98.7% (company-reported): claims accepted on first submission without rejection or correction |
| Days in A/R | Under 30 (company-reported) |
| Free first step | 90-day claims review with a written recovery roadmap within 5 business days |
For medical billing services in Massachusetts, the 3% covers the full claim cycle. Our medical billing services page lists each step, and the rate includes:
- eligibility verification and claim scrubbing
- coding and claim submission
- line-level payment posting from ERAs and EOBs
- denial management and payer follow-up
- A/R follow-up, including old A/R and backlog recovery
- monthly reporting
Old A/R is included in the same 3%: we work every open claim still inside a payer’s filing or appeal window, with no separate backlog fee. Our A/R follow-up and backlog recovery team picks up aged claims in the first month of the engagement.
A solo practice collecting $20,000 a month from insurers pays $600, and a practice collecting $60,000 a month pays $1,800. We don’t charge on patient copays or balances. Billing audits and audit defense, a patient help desk, and virtual assistants are add-on services priced separately.
Our provider credentialing costs $107 per insurance panel and covers CAQH profile setup and maintenance, primary source verification, applications, and status tracking. If you’re comparing credentialing services in Massachusetts, use that per-panel figure as your benchmark.
Our published turnaround targets:
- claim submission within 24 hours of receiving documentation
- ERA and EOB payments posted every day
- denial root causes analyzed within 24 hours
- appeals filed within 48 hours
- A/R follow-up every week
MassHealth requires most fee-for-service claims within 90 days of the date of service under 130 CMR 450.309, and a 24-hour submission target leaves most of that window free for fixing rejections. In MassHealth billing, a late first submission can cost you the claim.
For commercial plans, 211 CMR 52.00 now requires most prior authorization decisions within two working days of receiving complete information. A team that sends complete requests the first time starts that two-day clock sooner, and that habit sits at the center of our approach to revenue cycle management in Massachusetts.
We work as a single medical billing partner from credentialing to payment for:
- solo and small practices, our most common clients
- groups of 2 to 50+ providers, with RVU reporting by provider
- multi-specialty clinics, with specialty-matched coders
- hospitals, with UB-04 and DRG processing
- new practices that need credentialing from day one
Our coders work inside Epic, Cerner, athenahealth, AdvancedMD, eClinicalWorks, SimplePractice, WebPT, DrChrono, TherapyNotes, Kareo, and Modernizing Medicine, so you keep the EHR you already use.
Keep in mind: we’re Texas-based and serve Massachusetts remotely, which suits practices that want full RCM and price clarity over an in-person biller. Credentialing carries its own fee of $107 per panel.
Experian Health’s State of Claims 2025 survey found 41% of providers report denial rates of 10% or higher, which is why we publish a defined first-pass figure instead of a vague promise. Sarah Mitchell, NP-C, of Cornerstone Family Practice in Austin, Texas, gained Aetna and BCBS approval in 11 weeks after four months of failed attempts.
Our New England clients include Raul Avila, LPC, of Alternative Therapy in Hamden, Connecticut, who has worked with us for over a year. Connecticut practices bill the same Medicare contractor as Massachusetts practices: NGS, Jurisdiction K.
We sign a BAA before anyone opens a patient record, and we work in a SOC 2 Type II audited environment with 256-bit AES encryption. Our coders hold AAPC and AHIMA credentials and match to 75+ specialties. Our First-Cycle Guarantee reads: “If we don’t find hidden revenue leaks in your first billing cycle, we work for free until we do.”
If you’d like to see what we’d find in your last 90 days of claims, we’ll send a written review within five business days. Request your free 90-day claims review.
2. MedHeave Healthcare Services: Best for Boston Practices Wanting a Posted Rate
MedHeave Healthcare Services is a medical billing company at 1 Washington Mall in Boston that offers about 21 billing and RCM services and cites more than six years of experience on its site.
MedHeave’s services include coding, credentialing, prior authorization, denial management, eligibility checks, patient billing, and No Surprises Act dispute support. The company lists around 70 specialties, led by behavioral health, and its downtown address suits practices that want medical billing in Boston from a local firm.
MedHeave publishes a rate of 4% to 7% of collections and states that clients can end agreements with 30 days’ notice. Credentialing runs $250 per application. The site lists figures such as a 90%+ first-pass rate and A/R under 40 days but doesn’t explain how it measures them, and MassHealth appears only inside a client testimonial.
MedHeave fits if you want a Boston-based firm with a posted rate range and a short exit window. Ask which point in the 4% to 7% range applies to your specialty and monthly volume, and ask for the formula behind each metric.
3. Billing Advantage: Best for Mental Health and Therapy Practices
Billing Advantage is a medical billing company at 5 Market Square in Amesbury, Massachusetts, founded in 2004, that grew out of its own in-house psychotherapy practice and says it serves more than 300 clinicians in 22 states.
Billing Advantage handles claim submission, denials, A/R follow-up, payment posting, secondary billing, patient statements, credentialing, and practice consultation. Its specialty list covers 12 fields, including mental health, psychiatry, cardiology, wound care, and occupational, speech, and physical therapy.
The company publishes a rate of 5% to 7% of the amount collected, plus a startup fee of $500 per clinician, capped at $2,000. Its site lists credentialing at $300 per provider for each insurance company.
Billing Advantage reports a 98.43% collections rate on submitted claims, measured on its own psychotherapy practice. We found no published exit terms or Massachusetts payer specifics.
Choose Billing Advantage if you run a therapy or counseling practice and want a team that bills for its own clinic. Ask for contract length and notice terms in writing before you sign, and add the startup fee to your first-year cost.
4. Medical Healthcare Solutions (MHS): Best for Specialty Groups and Student Health Centers
Medical Healthcare Solutions (MHS) is a Massachusetts medical billing company at 300 Brickstone Square in Andover that established its billing division in April 1991 and incorporated in 1995.
MHS offers revenue cycle management, coding, credentialing, payer enrollment and revalidation, denials and appeals, revenue analytics, and practice management consulting. Its specialties include orthopedics, gastroenterology, anesthesiology, pain management, urology, podiatry, ambulatory surgery centers, and university student health.
MHS publishes a 98.5% clean claim rate, described as claims paid correctly the first time, and a 93.5% first-pass resolution figure. The company sends pricing with a practice analysis instead of posting it, and we found no published exit terms. MHS says it serves ACOs, hospital-based practices, and large group practices but doesn’t name Massachusetts payers.
MHS suits you if you run a specialty group or student health center and value tenure, since the company reports a 14.5-year average client tenure. Ask how the company calculates the 98.5% figure and which claims it leaves out of the count.
5. Emerald Health: Best for Practices Wanting Named Massachusetts Payer Experience
Emerald Health LLC is a medical billing company at 237A State Road in Dartmouth, Massachusetts, founded in 2010 according to its own site and BBB records, serving South Coast and statewide practices.
Emerald handles claims, denials, payment posting, coding, eligibility and prior authorization, A/R follow-up, and staff augmentation. Its specialties include internal medicine, family medicine, geriatrics, neurology, endocrinology, behavioral health, sleep medicine, physiatry, and gynecology.
Emerald doesn’t post a rate but advertises no setup fees and no multi-year lock-ins. Its site offers to refund 50% of a month’s fee if the denial rate tops 5% for 60 straight days, with exclusions and full terms on request. We didn’t cite its performance figures, because the numbers on different pages of its site don’t match.
Emerald’s Massachusetts page names BCBSMA, Harvard Pilgrim, Tufts, and MassHealth, the strongest local payer evidence among the firms we checked. Look at Emerald if a South Coast location and named payer experience matter most to you. Request the refund guarantee terms and current metrics in writing before you compare them with other firms.
6. Merrimack Billing Solutions: Best for Practices With Auto and Workers’ Comp Claims
Merrimack Billing Solutions is a medical billing company with an Andover, Massachusetts, mailing address on Bartlet Street, formed in 2007, that serves practices in Massachusetts, Maine, Vermont, New Hampshire, New York, and New Jersey.
Merrimack covers eligibility checks, charge and payment posting, claims including auto and workers’ compensation, denial follow-up, patient billing and soft collections, and help with provider credentialing. The company describes its clients as behavioral and medical practices without naming specialties.
Merrimack doesn’t publish a price, a defined metric, exit terms, or Massachusetts payer specifics on its site. The firm makes sense if your claim mix includes auto or workers’ comp cases, or if you bill across several New England states. Ask for pricing, scope, and contract terms on the first call.
7. Analytix Healthcare Solutions: Best for HME and DME Suppliers
Analytix Healthcare Solutions is a revenue cycle company at 800 West Cummings Park in Woburn, Massachusetts, operating since the mid-2000s, that builds its services around home medical equipment workflows.
Analytix handles eligibility, authorization, sales orders, certificates of medical necessity, claims, payment posting, denials, and A/R follow-up. The company serves HME and DME suppliers, dental offices, and physician practices.
Analytix doesn’t publish a price, a defined metric, exit terms, or Massachusetts payer specifics. Pick Analytix if you supply durable medical equipment and need order intake tied to billing. Physician practices should ask how much of the team’s daily work covers professional claims and which specialties it bills today.
8. New England Medical Billing (NEMB): Best for Ambulance, EMS, and School-Based Medicaid Claiming
New England Medical Billing (NEMB) is a billing company at 19 Norfolk Avenue in South Easton, Massachusetts, that has billed since 1993 and joined VSS Medical Technologies in 2017.
NEMB provides coding, claim submission, insurance verification, A/R management, self-pay collections, and documentation audits. Its focus areas are ambulance and EMS billing, school-based Medicaid claiming, and specialty clinics.
NEMB lists figures such as a 98% clean claim rate and under 10% of A/R past 90 days but doesn’t define them, and it doesn’t publish a price, exit terms, or Massachusetts payer names.
NEMB is the natural shortlist pick if you run an ambulance service or a school-based program with Medicaid claims. Office-based practices should confirm the team’s experience with their specialty, and ask whether credentialing falls inside the engagement.
9. Bradford Medical Associates: Best for Practices Billing in Massachusetts and New Hampshire
Bradford Medical Associates is a Massachusetts medical billing company at 43 High Street in North Andover that reports more than 25 years in business and serves practices in Massachusetts and New Hampshire.
Bradford files claims, follows up on unpaid claims, codes, and reports, and says it bills claims within 48 hours. Its specialties include cardiology, chiropractic, family and internal medicine, mental health, neurology, physical therapy, plastic surgery, podiatry, psychiatry, and radiology.
Bradford charges a percentage of collections without posting the figure, and it doesn’t publish a defined metric, exit terms, or Massachusetts payer specifics. Bradford works for practices that want a long-tenured local firm with a 48-hour billing habit. Ask whether credentialing or prior authorization falls within scope, since its site lists neither.
10. Comprehensive Practice Management: Best for Independent Practices Wanting CPA Oversight
Comprehensive Practice Management (CPM) is a medical billing firm at 680 Worcester Road in Framingham, Massachusetts, run by CPAs for independent solo and group practices.
CPM provides CPT and ICD-10 coding, data entry, insurance and patient billing, payment reconciliation, and revenue cycle management. The company says it serves all medical specialties, with a CPA acting as a de facto CFO for clients.
CPM doesn’t publish a price, a defined metric, exit terms, or Massachusetts payer specifics, and we couldn’t confirm a founding year on its site. CPM is worth a call if you want accounting oversight alongside billing in MetroWest. Ask how the team handles credentialing and prior authorization, since its site lists neither, and request sample monthly reports.
11. Boston Billing Solutions: Best for Solo In-Network Behavioral Health Practices
Boston Billing Solutions is headquartered at 50 Nashua Road in Londonderry, New Hampshire, not in Boston, and has served New England practices since 1997. If you’re shortlisting medical billing companies in Massachusetts by headquarters, it belongs in the out-of-state group.
Boston Billing Solutions offers Standard and Deluxe plans covering claims, A/R, and payment posting, plus eligibility checks, coding, authorization services, optional patient billing, and EHR. Its site says the company is open to solo in-network behavioral health practices, with other specialties on a waitlist.
The company offers per-claim and percentage plans without posting figures. It says it doesn’t lock providers into long-term contracts but doesn’t publish notice terms, a defined metric, or Massachusetts payer specifics. Solo therapists with in-network panels are the best fit, so confirm availability first if you run another specialty.
12. Coronis Health: Best for Hospitals and Health Systems
Coronis Health is a national revenue cycle company headquartered at 255 West Michigan Avenue in Jackson, Michigan, with Massachusetts offices in West Springfield and Westwood.
Coronis covers the full cycle, from enrollment, credentialing, eligibility, and prior authorization through inpatient and professional coding, clinical documentation improvement, denials, A/R, and underpayment recovery. Its specialties include anesthesia, emergency medicine, EMS, FQHCs, pathology, radiology, surgery, behavioral health, and hospitals and health systems.
Coronis lists a 90%+ clean claim rate without a definition and doesn’t publish a price, exit terms, or Massachusetts payer names. Its two local offices still give it a physical presence in the state.
Coronis fits if you run a hospital, health system, or large group that wants a firm with 10,000+ team members. Smaller practices should ask about minimums and whether a named team handles their account.
Other Billing Options Massachusetts Practices Ask About
These firms also appear on lists of medical billing companies in Massachusetts but didn’t make our ranked 12, because they’re software-led, facility-focused, or don’t list a Massachusetts address.
Table 2. Other firms practices ask about, checked November 5, 2026.
| Company | Headquarters | Type | Why it’s not in the ranked list |
|---|---|---|---|
| athenahealth | Boston, MA | EHR and practice software with billing | Software-first; billing comes with the platform |
| LogixHealth | Bedford, MA | RCM for EDs, urgent care, practices, hospitals | Emergency and facility billing focus |
| Transcure | Offices in TX, NJ, and FL | Billing and RCM company | No Massachusetts address listed |
| BellMedEx | No address on its site | Billing company | No published address to verify |
| Oxygen RCM | No street address on its site | Behavioral health billing | No published address to verify |
If you’re considering one of these firms, ask for the same three things we used to rank the list: price, a defined metric, and written exit terms.
Massachusetts Billing Rules Every Billing Company Must Handle
Medical billing in Massachusetts runs on six rule sets: MassHealth’s managed care structure, payer-specific filing deadlines, the 45-day prompt-pay rule, the 2026 prior authorization regulation, state credentialing timelines, and Medicare rules from NGS. Every one of the medical billing companies in Massachusetts on our list should explain each rule set without looking it up.
How MassHealth Is Structured in 2026
MassHealth is Massachusetts’ combined Medicaid and Children’s Health Insurance Program, and it covered 1,866,686 members as of July 31, 2026. More than 1 million of those members belonged to accountable care organizations (ACOs), according to the same MassHealth snapshot.
Table 3. MassHealth members by selected plan type, July 31, 2026. Source: MassHealth caseload snapshot and enrollment summary, July 2026.
| Plan type | Members (July 31, 2026) |
|---|---|
| ACO-A (Accountable Care Partnership Plans) | 798,606 |
| ACO-B (Primary Care ACOs) | 252,164 |
| Third-party liability (TPL) | 112,302 |
| Senior Care Options (SCO) | 78,036 |
| Primary Care Clinician (PCC) Plan | 60,298 |
| Fee-for-service (FFS) | 59,036 |
| One Care | 36,649 |
A member’s plan type sets where the claim goes and which filing window applies. Sound MassHealth billing means checking eligibility at every visit, because members can move between plans during the year.
Point32Health stopped offering the Tufts Health Together MCO on January 1, 2026, according to its provider notice, and MassHealth assigned those members to new plans. Some published billing lists still name the old plan, so check every 2026 claim against the member’s current assignment.
Timely Filing Deadlines by Massachusetts Payer
Massachusetts filing deadlines run from 90 days to one year depending on the payer, and MassHealth’s 90-day fee-for-service window sits among the shortest. Contracts can override these defaults, so compare each row with your own payer agreements.
Table 4. Initial claim filing limits by Massachusetts payer, verified November 5, 2026.
| Payer | Initial filing limit | Source |
|---|---|---|
| MassHealth fee-for-service | 90 days from the date of service; 12-month final deadline | MassHealth billing timelines |
| WellSense (MassHealth ACO and MCO plans) | 150 days | WellSense provider materials |
| WellSense Clarity (ACA and QHP plans) | 90 days | Same WellSense source |
| Blue Cross Blue Shield of Massachusetts (HMO, PPO) | 90 days from the date of service | BCBSMA claim submission guidance |
| BCBSMA indemnity | One year from the date of service | Same BCBSMA source |
| Tufts Health Plan commercial | 90 days from the date of service | Point32Health commercial provider manual |
| Tufts Health Public Plans | 90 days from the date of service | Point32Health provider update |
| Mass General Brigham Health Plan commercial | 90 days from the date of service unless the agreement says otherwise | MGB Health Plan commercial provider manual |
| Fallon Health (contracted) | 120 days from the date of service unless the contract says otherwise | Fallon Health provider announcements |
| Medicare fee-for-service (NGS) | One year from the date of service | 42 CFR 424.44 |
MassHealth gives you 90 days from the primary insurer’s EOB date when another payer pays first, and the final deadline stretches to 18 months for those claims. A claim that misses its window ends in a CO-29 timely filing denial, so your billing team should load each contract’s terms into its claim queue.
The 45-Day Prompt-Pay Rule and Interest
Under M.G.L. c.175 §108, an insurer must pay a claim or tell you in writing why it hasn’t within 45 days of receiving notice of the claim. If it does neither, interest of 1.5% per month accrues from day 45, capped at 18% a year, except on claims under fraud investigation.
Parallel sections apply a similar 45-day rule to Blue Cross Blue Shield plans, HMOs, and preferred provider arrangements: chapter 176A §8, chapter 176B §7, chapter 176G §6, and chapter 176I §2. Weekly A/R follow-up catches claims that pass day 45 with no payment or written reason, so your team can raise interest with the payer.
Prior Authorization Rules Under 211 CMR 52.00
As of November 2026, the Division of Insurance’s amended 211 CMR 52.00, with a register date of June 5, 2026, sets prior authorization rules for fully insured commercial plans in Massachusetts. The regulation calls prior authorization “prospective review.”
- Carriers must make initial decisions within two working days of receiving all necessary information.
- Carriers must decide urgent requests within 24 hours when the provider files an electronic request and documents the risk.
- A request counts as granted if the carrier misses its deadline.
- Approvals last at least 90 days or to the end of the benefit year, whichever comes first.
- Carriers can’t require in-network prior authorization for 14 service categories, including primary care, preventive care, maternity care, PT, OT, and speech therapy, and outpatient substance use disorder services.
- Carriers must offer peer-to-peer reconsideration within one working day.
- Carriers must give 60 days’ notice before adding a new prior authorization requirement.
These rules cover fully insured commercial products. They don’t reach self-funded employer plans or MassHealth fee-for-service, and a carrier can petition the Division for limited review of an exempt service after a rise in its use.
Under CMS-0057-F, Medicare Advantage plans, Medicaid and CHIP fee-for-service programs, and Medicaid managed care plans must decide standard requests within seven calendar days and expedited requests within 72 hours, starting in 2026. Our eligibility verification and prior authorization team tracks both clocks, and our guide to prior authorization denials covers the fix after a denial.
If prior authorizations or missed filing windows are costing you claims, our free 90-day claims review shows where, in writing, within five business days. Get your free 90-day claims review.
Credentialing Timelines in Massachusetts
Under 211 CMR 52.09, carriers must finish credentialing for 95% of clean, complete initial applications within 60 days, and for 95% of re-credentialing applications within 120 days. Carriers also face two interim deadlines:
- Carriers must flag an incomplete application within 20 business days.
- Carriers must give a status update by day 75.
A clean, complete application starts those clocks, so CAQH accuracy is the first thing to check when you compare credentialing services in Massachusetts. Our insurance credentialing services cost $107 per panel and include CAQH setup and maintenance.
Medicare Billing in Massachusetts
Massachusetts Medicare fee-for-service claims go to National Government Services (NGS) under A/B MAC Jurisdiction K, according to the CMS Jurisdiction K page. Jurisdiction K also covers Connecticut, Maine, New Hampshire, New York, Rhode Island, and Vermont, and Medicare gives you one year from the date of service to file.
CMS proposed CY2027 Physician Fee Schedule conversion factors of $33.17 for qualifying APM participants and $32.84 for everyone else, down from $33.57 and $33.40 in 2026, in its July 2026 proposed rule. Those figures stay proposed until CMS posts the final rule, so budget with a range.
CMS’s September 2026 state-by-state Medicare Advantage fact sheet counts 1,516,549 Medicare enrollees in Massachusetts and 97 Medicare Advantage plans for 2027, down from 103 in 2026. Mass Advantage ends its Medicare Advantage coverage on January 1, 2027, so confirm new coverage for those patients before their first 2027 visit.
What Do Medical Billing Companies in Massachusetts Charge?
Common Pricing Models
Most medical billing companies in Massachusetts charge a percentage of collections, and the rates we found posted on company websites in November 2026 ran from as low as 2.49% to 7%. Other firms charge per claim or a flat monthly fee.
- Percentage of collections: the vendor gets paid when you get paid, which ties its income to yours.
- Per claim: you pay a set fee for each claim, and the vendor earns the same fee whether it chases a denial or lets it sit.
- Flat monthly fee: easy to budget, though the scope often comes capped.
Compare scope before rate. Old A/R, credentialing, prior authorization, and patient statements are the services to check first, since some firms bill them outside the headline percentage.
Published Rates From Firms Marketing to Massachusetts Practices
Six firms that market to Massachusetts practices post a rate on their own websites as of November 2026. The scope behind each rate differs as much as the number.
Table 5. Rates posted on company websites, checked November 5, 2026.
| Company | Published rate | What the site says it covers |
|---|---|---|
| One O Seven RCM | 3% of insurance collections | Full RCM, including old A/R; credentialing $107 per panel |
| BellMedEx | As low as 2.49% of monthly collections | Appeals, software, clearinghouse; a cost table on the same page shows 2.99% |
| MedHeave Healthcare Services | 4% to 7% of collections | Billing and RCM services; credentialing $250 per application |
| Billing Advantage | 5% to 7% of the amount collected | Plus $500 startup fee per clinician (maximum $2,000); credentialing $300 per provider per payer |
| Transcure | 5% of monthly collections | No setup fees; scope not itemized on the pricing page |
| Oxygen RCM | 5% for individual and small practices | Behavioral health billing; conditions behind the asterisk not stated |
Affordable medical billing solutions come down to total cost. Add startup fees, credentialing charges, and any backlog fees to the percentage before you compare, because a lower headline rate can cost more once those items reach a separate invoice.
In-House Billing vs. Outsourcing in Massachusetts
According to the BLS May 2025 state wage estimates, billing and posting clerks in Massachusetts earned a median annual wage of $56,110, and medical records specialists earned $60,350. Both sit above the national medians of $48,500 and $51,140.
At 3% of insurance collections, a practice collecting $20,000 a month pays One O Seven RCM $7,200 a year, and a practice collecting $60,000 a month pays $21,600. Both totals fall below one billing clerk’s median wage, before you add benefits.
An in-house team also carries benefits, software, clearinghouse fees, training, and coverage for vacations and turnover. Our pages on billing for small practices and group practice billing break down scope by practice size.
Track your net collection rate before and after any change, since it shows what you collected against what you could have collected. That one number gives you the fairest read on revenue cycle management in MA, in-house or outsourced.
How to Choose a Medical Billing Company in Massachusetts
The right medical billing partner for a Massachusetts practice can answer eight questions in writing before you sign. Ask each one of every firm on your shortlist, including us.
- What does your rate include? Ask about old A/R, denials, credentialing, prior authorization, and patient statements. If you need medical billing and practice management services together, ask whether the rate covers the software too.
- Which metrics do you publish, and how do you define them? Ask for first-pass acceptance, days in A/R, and denial rate by category, each with its formula. Our guide to A/R aging explains the buckets to request.
- How do I leave? Get contract length, notice period, and cancellation penalties in writing. With month-to-month terms and 30-day notice, you can leave if service slips.
- How do you handle MassHealth and ACO plans? Medical billing companies in Massachusetts should check plan type at every visit and track the 90-day fee-for-service window. Ask how the team handles a member who switches ACOs mid-year.
- How do you work under 211 CMR 52.00? Look for complete first submissions, tracking of deemed approvals, and a process for the 60-day notices carriers send before adding requirements.
- Do you handle credentialing, and on what timeline? A good answer ties to the 211 CMR 52.09 clocks: 60 days for clean initial applications and 120 days for re-credentialing.
- Will you sign a BAA, and where do payments go?HHS guidance lists billing as a business associate function, so expect a BAA before any data access. Under 130 CMR 450.331, MassHealth doesn’t pay billing agents and holds the provider responsible for the agent’s acts, so payments belong in your practice’s own account.
- What will I see each month? Expect denials by category, payer performance, and net collection rate. Our denial management services page shows the denial reporting we send.
Many Massachusetts medical billing companies will answer some of these on a call. Ask for all eight in writing, and see our guide to choosing a billing partner for a deeper walkthrough.
Want these eight answers from us in writing? We’ll include them with your free 90-day claims review. Request your free claims review.
Behavioral Health Billing in Massachusetts
Behavioral health practices in Massachusetts have four state-specific protections that behavioral health billing companies should know, plus a federal telehealth runway through December 31, 2027.
- M.G.L. c.175 §108(14) bars most retroactive denials of behavioral health claims after 12 months, and the insurer must explain the reason and give you 30 days to fix the claim.
- Under 211 CMR 52.07, carriers can’t require in-network prior authorization for outpatient substance use disorder services or for pharmaceuticals that treat serious persistent mental illness.
- Under 211 CMR 52.11(18), a carrier’s base fee schedule for behavioral health E/M services can’t fall below its schedule for primary care providers of the same or similar licensure in the same region.
- M.G.L. c.175 §47MM requires in-network behavioral health telehealth, by audio-video or audio-only, to pay at least the in-person rate, and caps telehealth cost-sharing at the in-person level.
CMS’s October 2026 telehealth FAQ says Medicare telehealth flexibilities run through December 31, 2027. CMS also proposed keeping in-person visit requirements from applying to RHC and FQHC mental health visits furnished through December 31, 2027.
Our behavioral health RCM guide covers these rules in more depth, and our specialty billing teams work across 75+ specialties at the same 3% rate. Ask the behavioral health billing companies you compare how they apply the 12-month retroactive denial limit.
2027 Changes Massachusetts Practices Should Prepare For
These January 1, 2027 dates affect medical billing companies in Massachusetts and the practices they serve. Each row names the change, the step to take, and the source.
Table 6. Massachusetts billing changes taking effect January 1, 2027, verified November 5, 2026.
| Date | Change | What to do | Source |
|---|---|---|---|
| January 1, 2027 | Patients First Act price transparency provisions begin; penalties up to $2,500 per instance | Update scheduling scripts for network status and cost notices | mass.gov Patients First notice |
| January 1, 2027 | MassHealth won’t pay claims that list unenrolled providers | Confirm every ordering, referring, and prescribing provider on your claims is enrolled | All Provider Bulletin 421 |
| January 1, 2027 | MassHealth ACO changes; Revere Health Choice becomes Bookmark Care Network | Update plan names and payer mapping | All Provider Bulletin 422 |
| January 1, 2027 | Mass Advantage ends its Medicare Advantage coverage | Verify new coverage before the first 2027 visit | Mass Advantage 2027 termination notice |
| January 1, 2027 | CMS-0057-F prior authorization API requirements for impacted payers | Ask payers about electronic prior authorization | CMS-0057-F (linked above) |
| January 1, 2027 | 211 CMR 52.07(15) standards apply if a carrier implements a prior authorization API | Track which carriers launch APIs | 211 CMR 52.00 (linked above) |
| January 1, 2027 | CY2027 Medicare conversion factors take effect (proposed $33.17 and $32.84) | Rebudget Medicare revenue once the final rule posts | CY2027 PFS fact sheet (linked above) |
The 211 CMR API standard applies only if a carrier builds a prior authorization API, so track each carrier’s plans instead of assuming a mandate. Our medical billing audit checklist covers national coding and edit updates, and a medical billing audit before January catches plan-name and enrollment gaps.
Frequently Asked Questions
Why is One O Seven RCM the best medical billing company in Massachusetts?
One O Seven RCM ranks first because it publishes three things most billing companies don’t: an all-inclusive rate of 3% of insurance collections, a defined 98.7% first-pass acceptance rate (company-reported), and month-to-month terms with 30-day notice and no cancellation penalties.
The 3% includes old A/R inside any payer’s filing or appeal window, and credentialing costs $107 per panel. Our team targets claim submission within 24 hours, which leaves most of MassHealth’s 90-day window open for corrections. See our revenue cycle management services for the full scope of revenue cycle management in Massachusetts we provide from Texas.
What are the top medical billing companies in Massachusetts?
As of November 2026, our list ranks One O Seven RCM first, followed by MedHeave Healthcare Services, Billing Advantage, Medical Healthcare Solutions, Emerald Health, Merrimack Billing Solutions, Analytix Healthcare Solutions, New England Medical Billing, Bradford Medical Associates, and Comprehensive Practice Management. Boston Billing Solutions and Coronis Health complete the 12.
We split Massachusetts-headquartered firms from out-of-state ones and ranked each on six criteria: verified headquarters, published price, a defined metric, written exit terms, service breadth, and Massachusetts payer readiness. Apply the same six tests to any firm you find outside our list.
How much do medical billing companies in Massachusetts charge?
Most charge a percentage of collections. The rates we found posted on company websites in November 2026 ran from as low as 2.49% to 7%, and One O Seven RCM charges an all-inclusive 3% of insurance collections with no setup fee or monthly minimum.
Check scope next. Some firms add startup fees of up to $2,000, credentialing at $250 to $300 per application or payer, or separate charges for old A/R. Add every fee to the rate before you compare totals, and ask each firm to put its full fee schedule in writing.
How much do medical billers make in Massachusetts?
Billing and posting clerks in Massachusetts earned a median of $56,110 a year ($26.98 an hour) in May 2025, according to the Bureau of Labor Statistics, and medical records specialists earned a median of $60,350. Both figures top the national medians.
Massachusetts employed about 7,430 billing and posting clerks and about 3,500 medical records specialists in May 2025. Those wages come before benefits, software, and training. For comparison, a practice collecting $20,000 a month from insurers pays $7,200 a year at a 3% rate.
Can you outsource medical billing in Massachusetts?
Yes. Massachusetts practices can outsource billing if the vendor signs a HIPAA business associate agreement, because HHS treats billing as a business associate function. Medical billing in Massachusetts also brings MassHealth rules that shape how you set up the arrangement with any vendor.
Under 130 CMR 450.331, MassHealth doesn’t pay billing agents and holds the provider responsible for the agent’s acts, so MassHealth payments should go to your practice’s own account. Your vendor also has to file MassHealth fee-for-service claims within 90 days of the date of service.
Why choose a medical billing company that knows Massachusetts payers?
Massachusetts payers use different filing windows, from 90 days at MassHealth fee-for-service and BCBSMA HMO and PPO plans to 150 days at WellSense’s MassHealth plans and one year for BCBSMA indemnity. A medical billing company in Massachusetts that mixes them up loses claims.
More than 1 million MassHealth members belonged to ACOs as of July 31, 2026, and MassHealth has announced more ACO changes for January 1, 2027. The June 2026 version of 211 CMR 52.00 also changed prior authorization deadlines for fully insured commercial plans, so your vendor needs the 2026 rule set.
Where is Boston Billing Solutions located?
Boston Billing Solutions is headquartered at 50 Nashua Road, Suite 207, in Londonderry, New Hampshire, not in Boston, according to BBB records and the company’s own website. BBB lists its founding date as November 1, 1997, and the company serves New England practices.
The company’s site says it’s open to solo in-network behavioral health practices, with other specialties on a waitlist. We list it in the out-of-state group of our ranking at #11, alongside Coronis Health at #12.
What is the MassHealth timely filing limit?
MassHealth requires initial fee-for-service claims within 90 days of the date of service, or within 90 days of the primary payer’s EOB when other insurance pays first. Claims first submitted on time have a 12-month final deadline from the date of service.
MassHealth managed care plans set their own limits, such as 150 days at WellSense’s MassHealth plans and 90 days at Tufts Health Public Plans. Sound MassHealth billing starts with an eligibility check at each visit, so the claim reaches the right plan on the first try.
Are there medical billing companies near me in Massachusetts?
Yes. Massachusetts-based billing firms have headquarters in Andover, North Andover, Woburn, Framingham, Amesbury, Dartmouth, South Easton, and Boston. Those towns hold most of the medical billing companies in Massachusetts on our list, and billing work runs through your EHR from anywhere, so payer knowledge matters more than distance.
Practices in Worcester, Springfield, and Lowell can work with any of these firms at a distance, and Coronis Health lists an office in West Springfield. For medical billing in Boston, MedHeave Healthcare Services keeps a Boston address. If you searched for medical billing companies near me, compare the three published proofs before you compare miles.
What are the top 5 medical billing companies in the USA?
No government agency or professional association publishes an official national ranking of medical billing companies. Any top 5 list you find reflects its publisher’s own criteria, so check how the list judged price, metrics, and contract terms before you rely on it.
Compare national firms on the same proofs we used here: a published rate, a defined metric, and written exit terms. Our national billing company comparison covers third-party firms that serve practices across state lines.
What are the major healthcare companies in Massachusetts?
Major health insurers and systems that Massachusetts practices bill or work with include MassHealth, Blue Cross Blue Shield of Massachusetts, Point32Health, Mass General Brigham, WellSense Health Plan, and Fallon Health. Each sets its own filing window and prior authorization process.
Point32Health formed on January 1, 2021, when Harvard Pilgrim Health Care and Tufts Health Plan combined, and it runs both brands. Mass General Brigham also runs its own health plan, whose commercial claims carry a 90-day filing limit. athenahealth, the practice software company, keeps its headquarters in Boston.
The Bottom Line
The best medical billing companies in Massachusetts publish their price, define their metrics, and put exit terms in writing, and they know MassHealth’s 90-day window and the 2026 prior authorization rules by heart. Use those four tests on any shortlist you build.
One O Seven RCM publishes all three proofs and covers the full cycle, including old A/R, for medical billing services in Massachusetts at one rate. That combination puts us first among medical billing companies in Massachusetts on this list, and our billing services at 3% of insurance collections page shows the full scope.
We publish the same kind of comparison for Texas, Florida, and California if your group bills in more than one state.
If you’d like to see what we’d find in your last 90 days of claims, we’ll send a written review within five business days, with no obligation. Request your free 90-day claims review.
Sources
Sources checked for this guide. Links open in a new tab.
| Source | Publisher and date | Used for |
|---|---|---|
| MassHealth caseload snapshot and enrollment summary | MassHealth, July 2026 | Member counts by plan type |
| 130 CMR 450.000 | MassHealth, current regulation | Filing limits, billing agents |
| Billing timelines and appeal procedures | MassHealth, accessed November 5, 2026 | 90-day, 12-month, and 18-month deadlines |
| All Provider Bulletin 421 | MassHealth, 2026 | 2027 provider enrollment rule |
| All Provider Bulletin 422 | MassHealth, 2026 | 2027 ACO changes |
| Tufts Health Together MCO notice | Point32Health, 2025 | 2026 plan discontinuation |
| 211 CMR 52.00 | Division of Insurance, June 5, 2026 | Prior authorization, credentialing, BH fee schedule |
| M.G.L. c.175 §108 | Massachusetts Legislature, current statute | Prompt pay, BH retroactive denials |
| M.G.L. c.175 §47MM | Massachusetts Legislature, current statute | Telehealth parity |
| Patients First pricing transparency notice | Commonwealth of Massachusetts, 2026 | 2027 notice rules |
| BCBSMA claim submission guidance | Blue Cross Blue Shield of Massachusetts, accessed November 5, 2026 | Filing limits |
| Tufts Health Public Plans update | Point32Health, accessed November 5, 2026 | Filing limit |
| Point32Health commercial and MGB Health Plan commercial provider manuals | Point32Health; Mass General Brigham Health Plan, 2026 | Commercial filing limits |
| Fallon Health provider announcements | Fallon Health, accessed November 5, 2026 | Filing limit |
| WellSense behavioral health insourcing overview | WellSense Health Plan, 2026 | Filing limits |
| A/B MAC Jurisdiction K | CMS, accessed November 5, 2026 | Medicare contractor |
| CY2027 Physician Fee Schedule proposed rule fact sheet | CMS, July 2026 | Proposed conversion factors, RHC and FQHC mental health |
| CMS-0057-F fact sheet | CMS, 2024 | Federal prior authorization timelines and APIs |
| CMS 2027 state-by-state Medicare Advantage and Part D fact sheet; CMS Telehealth FAQ | CMS, September and October 2026 | Enrollment, plan counts, telehealth dates |
| Business associates FAQ | HHS, current guidance | BAA requirement for billing |
| May 2025 state occupational employment and wage estimates | Bureau of Labor Statistics, 2026 release | Wages and employment |
| Experian Health State of Claims 2025; BBB business profiles; company websites | Various, accessed November 5, 2026 | Denial survey, founding dates, competitor facts |
