2023 ACO launch guidance

Programs and policies


As of April 1, 2023, all primary care providers (PCPs) participating in MassHealth’s ACO program will be paid through the Primary Care Sub-Capitation Program.

Continuity of care
View our augmented continuity of care policy regarding patients under an active treatment plan during their transition to a new WellSense ACO plan.

Helpful resources

Marketing materials

Find helpful resources for ACO members including office flyers, postcards and more.

View materials

WellSense ACO overview provider training
MassHealth ACOs and included programs overview


Background information on ACO program changes

There are a number of changes starting on April 1 as a result of MassHealth’s renewal of the ACO program. These include:

  • Realignment of ACO partnerships
    ACOs are a partnership between provider groups and health plan partners. In some cases, established ACOs are seeing certain providers either joining or leaving the ACO. Other ACOs are changing carrier partners. For WellSense specifically, we have welcomed four new ACOs with provider partners who have switched from their former health plan partner to us. WellSense is also experiencing some changes in the provider groups that we partner with in our WellSense Community Alliance ACO (BACO). A summary of the changes to our ACO structures is summarized in the table below.

    Due to these changes, it’s very important to check your patients’ ID cards for updated information. In addition, you should carefully review prior authorization requirements, as they may have changed. More details about how these changes impact prior authorization requirements and continuity of care are available in our Augmented Continuity of Care Policy.

New ACOs
ACO Name Key Providers
WellSense Care Alliance
  • Tufts Medical Center
  • Lowell Community Health Center
  • Lowell General Hospital
  • MelroseWakefield Hospital  
East Boston Neighborhood Health WellSense Alliance
  • East Boston Neighborhood Health Center
  • South End Community Health Center
  • Winthrop Neighborhood Health
WellSense Boston Children’s ACO
  • Boston Children’s Hospital
  • Pediatric Physicians’ Organization at Boston Children’s Hospital
WellSense BILH Performance Network ACO
  • Beth Israel Deaconess Medical Center
  • Lahey Hospitals & Medical Center
  • Mount Auburn Hospital
  • Winchester Hospital
  • Beverly & Addison Gilbert Hospitals
  • Bowdoin Community Health Center
  • South Cove Community Health Center
  • Health Care Associates
  • Anna Jaques Hospital
  • Beth Israel Deaconess Hospital - Milton
  • Beth Israel Deaconess Hospital - Needham
  • Beth Israel Deaconess Hospital - Plymouth
  • New England Baptist Hospital


Existing ACOs

ACO Name Key Providers
WellSense Community Alliance New Partners: 
  • Cape Cod Healthcare
  • Harvard Street Neighborhood Health Center
  • Compass Medical
Departing Partners: 
  • Greater New Bedford Community Health Center
  • Harrington Healthcare System
WellSense Mercy Alliance Same as current
WellSense Signature Alliance Same as current
WellSense Southcoast Alliance Same as current


  • Primary care sub-capitation
    MassHealth is changing the way primary care providers (PCPs) are reimbursed. Starting on April 1, PCPs will receive a monthly per-member per-month payment rather than fee-for-service payments for primary care services. More information is available on our Primary Care Sub-Capitation Program page.
  • Formulary changes
    Effective April 1, MassHealth is fully unifying their Unified Pharmacy Product List (UPPL) across all health plans. New ACO members joining WellSense as a result of the new waiver contracts will be granted a transition period until June 1, 2023, during which they may fill existing prescriptions that may otherwise require prior authorization to pay. To find covered alternatives or which drugs require prior authorization, search the MassHealth drug list. Prior authorization requirements will resume for applicable drugs to continue coverage of existing prescriptions after June 1, 2023. Information on how to submit a prior authorization request is available at on our Prior Authorizations page.
  • Community Partners
    MassHealth has re-procured community partners (CPs) for this new waiver. However, some existing CPs are experiencing service area changes, others are leaving the network and some will be merging with another CP organization. This means that you may be working with different CPs than you were before.
Member eligibility and enrollment

Most members whose PCP is switching ACOs or health plans should have received a letter in the mail from MassHealth in early February outlining the change. This letter told them there is nothing they need to do if they would like to stay with their PCP, but it also outlined how the member can change ACOs. In addition to the letters from MassHealth, WellSense is sending welcome kits, new ID cards and PCP attribution letters to our new members introducing them to our plan.

At the start of the new ACO period, some members may not be assigned to the correct ACO. In these situations, primary care providers should see patients and bill their current insurer of record normally.

Claims for members covered by a WellSense plan will be paid according to WellSense’s Augmented Continuity of Care Policy.

If the patient is or will be part of the primary care provider’s panel, then they will need to switch ACOs in order to maintain access after the continuity of care period. Members will need to contact MassHealth Customer Service 800-841-2900 (TTY: 800-497-4648) or visit masshealthchoices.com to change plans.

Only MassHealth can update a member’s enrollment. The patient should call MassHealth Customer Service at 800-841-2900 (TTY: 800-497-4648) or visit masshealthchoices.com.

Yes. MassHealth sent letters to ACO patients in early February alerting them to changes to their MassHealth insurance carrier and to their opportunity to change their health plan by letting MassHealth know before March 31, 2023.

After April 1, 2023, members will have a plan selection period until June 3, 2023 to try out their assigned ACO plan and change their ACO plan for any reason.

Starting July 1, 2023, most members will be in a fixed enrollment period. During the fixed enrollment period, members can only change health plans for specific reasons (e.g. member moves out of the ACO service area). 

Certain members will not have a fixed enrollment period and can change their health plan at any time of the year (e.g., children under age 1 or members in DCYF custody). Members must go directly to MassHealth to request health plan enrollment changes as outlined above.

Starting on April 1, 2023, you can update PCP assignment changes by visiting the WellSense provider portal. Your patient can also request their own PCP assignment change by visiting their member portal or by calling WellSense customer service starting April 1, 2023.

Yes, providers can verify eligibility in several ways:

Benefits and claims

Nothing. MassHealth benefits are standard across all carriers.

Your patients will experience a change to their pharmacy network, but MassHealth’s UPPL means that there will also be no difference in their prescription drug benefit. Patients may also experience changes to referral or prior authorization requirements as well as different extras, like free bike helmets.

For more information on WellSense’s member extras and WellSense’s pharmacy network, please visit our Pharmacy page.

Yes. WellSense has three delegated vendors who administer benefits. They are:

You can contact WellSense Provider Services at 888-566-0008. You can also contact your assigned Provider Relations Consultant or send the Provider Relations team an email at provider.info@wellsense.org.

For behavioral health provider services, please contact 866-444-5155. 

Provider network

Yes. While there is a lot of overlap between carriers’ networks, they are not exactly the same. You can check WellSense’s various provider directories online to validate whether a particular provider is in-network:
•    Medical providers: Visit WellSense’s Find a Provider page
•    Behavioral health providers: Visit Carelon Behavioral Health’s website
•    Pharmacy: Visit Express Scripts’ website

There will be no changes to dental networks, as dental is a carve-out benefit that is managed by MassHealth.

Vision hardware (like eyeglasses) is also managed by MassHealth. Treatment for medical conditions of the eye are covered by the ACOs, and those networks could change. Please visit WellSense’s Find a Provider page for more information.

We encourage providers to help members transition care to an in-network provider when possible. However, in the case of established relationships, new members joining WellSense as a result of the 2023 ACO launch will be covered by WellSense’s Augmented Continuity of Care Policy. Providers may submit a prior authorization request as outlined in the policy.

Should providers believe that their patients should continue to see an out-of-network provider for established care after July 1, 2023, providers should submit a new prior authorization request to WellSense. WellSense will use the criteria from its Out-of-Network Services Policy to review.

No. None of WellSense’s Medicaid plans require referrals for in-network specialists. If your patient needs to see an out-of-network specialist, then prior authorization is required.

Continuity of Care, including Medical and Pharmacy

Please refer to WellSense’s Augmented Continuity of Care Policy regarding any questions on this topic.

For information on what services require prior authorization and how to submit requests: