130 CMR, § 450.331 - Billing Agencies

(A) The MassHealth agency processes claims that are submitted by a billing agent on behalf of a provider. At the written request of a provider, the MassHealth agency may also mail payments and remittance advices to a billing agent, but such payments are payable to the provider only, and in no event are payable to the billing agent. The MassHealth agency does not make payments to a billing agent.

(B) The MassHealth agency recognizes a billing agent solely and strictly as the provider's agent. A billing agent is not considered a "provider" by the MassHealth agency. A provider's use of a billing agent does not relieve the provider of any responsibility imposed elsewhere in these regulations for the claims that the provider submits or that are submitted on the provider's behalf. Any provider that engages a billing agent for the preparation and submission of claims to the MassHealth agency is fully responsible to the MassHealth agency for all acts by such billing agent with actual or apparent authority to perform such acts, notwithstanding any contrary provisions in any agreement between the provider and the billing agent. In case of any violations of laws, rules, or regulations, or of the provider contract arising out of the acts of the billing agent, the provider is fully liable as though they were the provider's own acts.

Notes

130 CMR, § 450.331

Amended by Mass Register Issue 1341, eff. 6/16/2017.