networkupdate

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Network update

UMass Memorial Health may leave the Blue Cross Network

Questions?

Contact Network Management and Credentialing Services
at 1-800-316-BLUE (2583).

Quick Links

UMass Memorial Health and Blue Cross Blue Shield of Massachusetts are actively negotiating contract renewal terms. Both organizations remain committed to reaching a mutually acceptable agreement, yet we haven’t been able to agree on rates that would keep UMass Memorial Health in our network.

UMass Memorial Health is an important partner, and we value the care they provide to our members. Our contract conversations continue, and we remain confident of reaching an agreement before December 31. Our goal is to ensure that UMass Memorial Health has the necessary resources to care for our members while being responsive to our customers who continue to bear the burden of the relentless rise in the cost of health care.

If we are unable to reach an agreement, UMass Memorial Health and its contracted hospitals, satellite locations, and primary affiliated providers will be out of our network for dates of service beginning on January 1, 2026. This change doesn’t apply to Medicare Advantage members.

Important details

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Organizations leaving the network

UMass Memorial Health includes UMass Memorial Health hospitals, satellite locations, and primary affiliated providers. See the list of UMass Memorial hospitals in the “Hospital alternatives” section.

Note that Milford Regional Medical Center, part of the UMass Memorial Health hospital system, will remain in our network and is not part of the current contract renewal discussions.

Products and health plan benefits affected

UMass Memorial Health leaving the network affects members belonging to these plans:

HMO/POS
PPO
Indemnity
Federal Employee Program
Managed Blue for Seniors, and Medex^®' Choice (a Medicare supplement health plan)

Our Medicare Advantage plans (Medicare HMO Blue and Medicare PPO) are not affected.

Hospital alternatives

See below for a list of alternatives to UMass Memorial Health hospitals in the same geographic area. For a complete list of health care providers, refer to Find a Doctor & Estimate Costs.

UMass Memorial Health Hospital name	Closest alternative hospitals
UMass Memorial Medical Center – Worcester University Campus: 55 Lake Ave North Memorial Campus: 119 Belmont Street Hahnemann Campus: 281 Lincoln Street	Baystate Medical Center – Springfield MetroWest Medical Center – Framingham Milford Regional Medical Center – Milford Saint Vincent Hospital – Worcester
UMass Memorial Health – HealthAlliance Clinton Hospital – Clinton Campus 201 Highland Street, Clinton	Emerson Hospital – Concord Heywood Hospital – Gardner Lowell General Hospital – Lowell Saint Vincent Hospital – Worcester
UMass Memorial Health - HealthAlliance – Clinton Hospital – Leominster Campus 60 Hospital Road, Leominster	Athol Hospital – Athol Emerson Hospital – Concord Heywood Hospital – Gardner Lowell General Hospital – Lowell Saint Vincent Hospital – Worcester
UMass Memorial Health – HealthAlliance-Clinton Hospital – Fitchburg Campus 275 Nichols Road, Fitchburg	Athol Hospital –Athol Emerson Hospital – Concord Heywood Hospital – Gardner Saint Vincent Hospital – Worcester
UMass Memorial Health – Marlborough Hospital Emergency Department 157 Union St, Marlborough	Beth Israel Deaconess Hospital – Needham Emerson Hospital – Concord MetroWest Medical Center – Framingham Milford Regional Medical Center – Milford Newton-Wellesley Hospital – Newton Saint Vincent Hospital – Worcester
UMass Memorial Health – Harrington Hospital Southbridge Campus 100 South Street, Southbridge Webster Campus 340 Thompson Rd, Webster	Baystate Wing Hospital – Palmer Baystate Medical Center – Springfield Mercy Medical Center – Springfield Milford Regional Medical Center – Milford Saint Vincent Hospital – Worcester

Ambulatory Surgi-Centers (ASCs) and Urgent Care Centers (UCCs)		Location
ASC	Worcester Surgical Center	Worcester
ASC	Surgical Eye Experts	Worcester
ASC	The Surgery Center at Shrewsbury	Shrewsbury
UCC	CareWell Urgent Care	Northborough
UCC	CareWell Urgent Care	Worcester
UCC	AFC Urgent Care Worcester	Worcester
UCC	AFC Urgent Care Marlborough	Marlborough
UCC	ConvenientMD Urgent Care	Westborough
UCC	Marlborough Urgent Care	Marlborough
UCC	ConvenientMD Urgent Care	Sutton

Continuity of care

Our most important consideration is making sure we minimize disruption to our members’ care. We will let our members know about the continuity of care guidelines, including the continuity of care provisions from your Provider Services Agreements.

For commercial members

If you’re providing services now to members who are	They may be covered at the in-network level	Action required
Pregnant	For 90 days following the date UMass Memorial Health leaves the network, or through the first postpartum visit, whichever is longer.	You can fill out a Continuity/Transition of Care Request Form for each member who meets continuity of care criteria and submit to us on their behalf before January 1, 2026. Or ask the patient to complete the form so they can continue to see you for a defined time or treatment, or until they transfer to another in-network provider.
Terminally ill	As long as needed.
Have a serious and complex condition, are receiving inpatient care, or are scheduled for a non-elective surgery	For 90 days following the date UMass Memorial Health leaves the network, or when active treatment is no longer required, whichever is earlier.

If you’re providing services now to members who are

They may be covered at the in-network level

Action required

Pregnant

For 90 days following the date UMass Memorial Health leaves the network, or through the first postpartum visit, whichever is longer.

You can fill out a Continuity/Transition of Care Request Form for each member who meets continuity of care criteria and submit to us on their behalf before January 1, 2026.

Or ask the patient to complete the form so they can continue to see you for a defined time or treatment, or until they transfer to another in-network provider.

Terminally ill

As long as needed.

Have a serious and complex condition, are receiving inpatient care, or are scheduled for a non-elective surgery

For 90 days following the date UMass Memorial Health leaves the network, or when active treatment is no longer required, whichever is earlier.

For Federal Employee Program (FEP) members

FEP members who:	And for:
Are pregnant can continue care with you through the postpartum period Have chronic or disabling conditions can continue care with you for up to 90 days if they are undergoing treatment Note: FEP members are instructed to call 1-800-689-7219 to request continuity of care.	*FEP Blue Standard Option: We will pay out-of-network rates. The member may be able to use preferred benefits for up to 90 days after you receive notice of the change. FEP Blue Basic and FEP Blue Focus:* The member will pay all charges. The member may be able to use preferred benefits for up to 90 days after you receive notice of the change. *Refer to fepblue.org for additional information.

FEP members who:

And for:

Are pregnant can continue care with you through the postpartum period
Have chronic or disabling conditions can continue care with you for up to 90 days if they are undergoing treatment

Note: FEP members are instructed to call
1-800-689-7219 to request continuity of care.

FEP Blue Standard Option*: We will pay out-of-network rates. The member may be able to use preferred benefits for up to 90 days after you receive notice of the change.
FEP Blue Basic and FEP Blue Focus*: The member will pay all charges. The member may be able to use preferred benefits for up to 90 days after you receive notice of the change.

*Refer to fepblue.org for additional information.

How we are supporting our members

To minimize disruption for our members, we’ve implemented the following transition plan:

As a courtesy, we have found new in-network primary care providers (PCPs) for members with an HMO plan. Members can keep the new PCP or choose a new one at any time.
Members may continue to be covered with their current UMass PCP for at least 30 days after the termination goes into effect. For that reason, the new in-network PCP match will be effective February 1, 2026.
All other HMO members and members with a PPO plan will receive either an email or a letter, depending on their specified communication preferences.

What you should know and do next

Click on the audience below that applies to you for the most current information and steps you must take.

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Clinicians who only belong to UMass Memorial Health (who have a hospital affiliation and admitting privileges only with UMass Memorial Health)

If we are unable to reach an agreement with UMass Memorial Health, as a non-participating physician or clinician, we will no longer reimburse you for services rendered to our members as described below.

If you’re caring for Blue Cross patients as a	In-network reimbursement ends
Primary care provider	January 30, 2026
Specialist	January 1, 2026 for physician and hospital services*

*If continuity of care applies, a longer time frame may apply.

If you only have a UMass Memorial Health contractual agreement and want to remain in-network you must:

Sign an agreement with another participating provider organization.
Obtain a hospital affiliation with admitting privileges at another participating hospital, OR an admitting arrangement with a participating hospitalist group that has admitting privileges at another participating hospital.
Log in to your CAQH Proview account and update these sections and re-attest:
- hospital affiliations
- admitting privileges
- demographic information
Email us at Provider-Enrollment@bcbsma.com no later than January 16, 2026, so that we may review and process your updates.

Clinicians affiliated with UMass Memorial Health and who have another primary hospital affiliation

If you are contracted as a UMass Memorial Health physician and/or with another physician group, this termination will not affect your other affiliation. You may continue seeing Blue Cross Blue Shield of Massachusetts members through your non-UMass Memorial Health group.
Nurse practitioners and physician assistants must have admitting arrangements with a Blue Cross network physician or hospitalist program.
Psychiatric nurse practitioners and psychiatric physician assistants do not require admitting arrangements.

For in-network coverage starting January 1, 2026, refer your Blue Cross patients to non-UMass Memorial Health facilities.

If you have	Then
A solo agreement or an agreement with another participating provider group A hospital affiliation with admitting privileges at another participating hospital, or An admitting arrangement with a participating hospitalist group that has admitting privileges at another participating hospital.	Log-in to your CAQH Proview account and update these sections: hospital affiliations admitting privileges demographic information Email us at Provider-Enrollment@bcbsma.com no later than January 16, 2026 so we may review and process your updates.

If you have

Then

A solo agreement or an agreement with another participating provider group
A hospital affiliation with admitting privileges at another participating hospital, or
An admitting arrangement with a participating hospitalist group that has admitting privileges at another participating hospital.

Log-in to your CAQH Proview account and update these sections:
1. hospital affiliations
2. admitting privileges
3. demographic information
Email us at Provider-Enrollment@bcbsma.com no later than January 16, 2026 so we may review and process your updates.

Forms

Forms and Links	Purpose
Continuity/Transition of Care Request Form	To help the members who meet continuity of care criteria to minimize disruption in care.
Your CAQH Proview account (You’ll need to update the hospital affiliations and admitting sections of the Integrated Massachusetts Application )	To get admitting privileges at another participating hospital, or an admitting arrangement with participating hospitalists who have admitting privileges at another participating hospital.
Contract Update Form for Physician Assistants and Ancillary Advanced Practice Nurses	To notify us of a change to your practice status. Use this form only if you are a PA or an Ancillary Advanced Practice Nurse.