Loading...
Revenue Cycle Management Services
in Boston, MA
Qualigenix runs the revenue cycle for Boston practices, from the eligibility check before a visit to the posted payment after it.
Request a Callback
Speak with our RCM specialists today.
How Qualigenix Serves Boston Practices
Qualigenix bills for independent Boston practices across 38+ specialties. Boston's payer mix leans hard on MassHealth. The Boston service area has 12 MassHealth health plan options for 2026, and a patient can move between them. A claim sent to the plan a patient left last month comes back denied, so our billers set up each plan as its own payer in your system. Medicare, six Senior Care Options plans, five One Care plans and the commercial carriers sit on top of that. Statewide rules, such as the MassHealth filing deadlines, are covered on our Massachusetts medical billing page. This page covers what's specific to Boston and Suffolk County.
What Medical Billing Services Does Qualigenix Provide in Boston?
Qualigenix medical billing services cover the full claim cycle for Boston practices: eligibility checks, charge review, claim scrubbing, submission, payment posting, denial appeals and A/R follow-up. We bill all payers, including the MassHealth plans in the Boston service area,
Medicare through National Government Services, and commercial carriers such as Blue Cross Blue Shield of Massachusetts. Pricing is a percentage of collections.
RCM for Suffolk County's MassHealth Plans
Qualigenix routes eligibility, authorization and claims to the MassHealth plan that covers the patient on the date of service. MassHealth tells providers to bill the plan its Eligibility Verification System (EVS) shows for that date, and our team checks EVS at every step.
Boston MassHealth Plan Options
MassHealth's January 2026 enrollment guide lists 12 plan options for the Boston service area: Accountable Care Partnership Plans: Fallon Health-Atrius Health Care Collaborative, Mass General Brigham Health Plan with Mass General Brigham ACO, Tufts Health Together with Cambridge Health Alliance (CHA), East Boston Neighborhood Health WellSense Alliance, WellSense Beth Israel Lahey Health (BILH) Performance Network ACO, WellSense Boston Children's ACO, WellSense Care Alliance and WellSense Community Alliance; Primary Care ACOs: Community Care Cooperative (C3) and Revere Health Choice; Managed care organization: WellSense Essential MCO; The MassHealth Primary Care Clinician (PCC) Plan. Each plan has its own referral, authorization and network rules. Qualigenix tracks them by plan, so the front-end check matches the plan that will pay.
Recent MassHealth Plan Changes
The Tufts Health Together MCO closed on January 1, 2026. Revere Health Choice becomes Bookmark Care Network on January 1, 2027. MassHealth's October 2026 bulletin also removes Tufts Medical Center from the Tufts Health Together with CHA hospital network, which changes where those members can be referred. We update eligibility, referral and payer settings before each change reaches your schedule.
Statewide MassHealth RCM Rules
Filing windows, waivers and appeals apply across the state, so our page on Massachusetts revenue cycle rules covers them once.
Medicare and Commercial Payers for Boston Practices
National Government Services processes Medicare Part A and Part B claims for Massachusetts. Qualigenix bills it, tracks each claim to payment and handles the crossover to MassHealth. Suffolk County has six Senior Care Options plans and five One Care plans for 2026, including new Mass General Brigham options. These Medicare Advantage plans, like MassHealth managed care plans, must decide standard prior authorization requests within 7 calendar days and urgent ones within 72 hours since 2026. State-regulated commercial plans changed on June 5, 2026, when Massachusetts Division of Insurance rules ended prior authorization for primary care, preventive care, maternity care, physical and occupational therapy, and outpatient substance use treatment. Self-insured employer plans aren't covered by those rules, so we check each patient's plan type before we drop an authorization step.
PROVEN RCM PERFORMANCE
Results Boston Practices Can Expect
These are company-wide figures across Qualigenix client practices, not Boston-only numbers.
98%
Claim accuracy
4.8%
Denial rate
97.7%
Net collections rate
54 → 36
Days in A/R
38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$1.6B+
Total charges handled
$923M+
Accounts receivable recovered
1,400+
Providers set up nationally
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ Clinics6-DAY ONBOARDING
How Onboarding Works
Qualigenix onboards RCM accounts in four steps, with billing live by day six on average.
01
Onboarding Call and Plan
We review your billing setup, denial trends and where revenue is leaking, then build a plan for your payer mix.
02
Software and Portal Setup
We work inside your existing EMR or EHR, set up payer portal access and learn your specialty's procedures.
03
Open Account Clean-Up
Specialists handle verification, coding, claim scrubbing, denials and posting on your open accounts.
04
Live by Day Six
Billing runs live in six days on average, and your older A/R is worked alongside new claims.
Loading Integrations...
WHY BOSTON PRACTICES CHOOSE QUALIGENIX
Why Boston Practices Choose Qualigenix
One accountable team across every stage, native EHR integration across 133 platforms, transparent monthly reporting by payer, and rapid six-day onboarding.
One Team, Every Stage
The same Qualigenix team handles eligibility, coding, billing, posting and follow-up. When a denial traces back to the front desk, the fix reaches the front desk in the same week.
Works Inside Your EHR
Qualigenix has worked in 133 EMR and EHR platforms. We run your revenue cycle inside your current system, so there's no migration and no new software for your staff.
Monthly Reports by Payer
You get a monthly report by payer, including each MassHealth plan, Medicare and your commercial carriers, with every metric defined. Collections, denials and A/R age are shown plainly.
Six-Day Average Onboarding
Most practices go live in six days on average. Older A/R is worked alongside new claims, so the switch doesn't leave a gap in cash flow.
BOSTON RCM FAQS
Frequently Asked Questions
Frequently asked questions regarding Boston MassHealth plan options, Senior Care Options, One Care, NGS Medicare crossovers, and RCM onboarding in Suffolk County.
Qualigenix is a revenue cycle management company serving independent practices in Boston across 38+ specialties. One team handles eligibility, authorization, coding, billing, posting, denials and A/R for MassHealth, Medicare and commercial payers. Book a meeting to walk through your revenue cycle.
It includes eight connected services: insurance verification, prior authorization, medical coding, medical billing, payment posting, denial management, A/R recovery and credentialing. Patient billing and monthly reporting by payer are part of the work too.
Yes. Qualigenix requests and tracks authorizations for MassHealth plans, SCO and One Care plans, Medicare and commercial carriers. We follow each plan's current list, including the services Massachusetts state-regulated plans stopped requiring authorization for in June 2026.
MassHealth claims go to the plan EVS shows for the date of service, and Medicare claims go to National Government Services, with crossover to MassHealth where a patient has both. Every claim is tracked until it's paid or closed.
Qualigenix works unpaid claims daily by payer and age, fixes denial causes at the front end and posts payments against expected rates. Across client practices, days in A/R have dropped from 54 to 36.
No. A Boston practice needs a team that knows MassHealth's plans, the Medicare contractor and Massachusetts commercial rules, and works inside its EHR. Qualigenix goes live in six days on average and reports results by payer each month.
Qualigenix charges a percentage of collections for revenue cycle management. The exact percentage depends on your specialty, claim volume and payer mix. Talk to a revenue cycle specialist for a quote.