130 CMR, 130 CMR 450.000 - Administrative and Billing Regulations

  1. § 450.101 - Definitions
  2. § 450.102 - Purpose of 130 CMR 400.000 through 499.000
  3. § 450.103 - Promulgation of 130 CMR
  4. § 450.105 - Coverage Types
  5. § 450.106 - Emergency Aid to the Elderly, Disabled and Children Program
  6. § 450.107 - Eligible Members and the MassHealth Card
  7. § 450.108 - Selective Contracting
  8. § 450.109 - Out-of-state Services
  9. § 450.110 - Hospital-determined Presumptive Eligibility
  10. § 450.112 - Advance Directives
  11. § 450.117 - Managed Care
  12. § 450.118 - Primary Care Clinician (PCC) Plan
  13. § 450.119 - Primary Care ACOs
  14. § 450.123 - Managed Care Compliance with Mental Health Parity
  15. § 450.124 - Behavioral Health Services
  16. § 450.130 - Copayments Required by the MassHealth Agency
  17. § 450.140 - Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services: Introduction
  18. § 450.141 - EPSDT Services
  19. § 450.142 - EPSDT Services: Medical Protocol and Periodicity Schedule and Dental Protocol and Periodicity Schedule
  20. § 450.143 - EPSDT Services: Description of Medical Protocol and Periodicity Schedule Visits (EPSDT Visits)
  21. § 450.144 - EPSDT Services: Diagnosis and Treatment
  22. § 450.145 - EPSDT Services: Claims for Visits
  23. § 450.146 - EPSDT Services: Claims for Laboratory Services, Audiometric Hearing Tests, Vision Tests, and Behavioral Health Screening (Physician, Physician Assistant, Certified Nurse Practitioner, Certified Nurse Midwife, Certified Clinical Nurse Specialist, and Community Health Center Providers Only)
  24. § 450.148 - EPSDT Services: Payment for Transportation
  25. § 450.149 - EPSDT Services: Recordkeeping Requirements
  26. § 450.150 - Preventive Pediatric Health-care Screening and Diagnosis (PPHSD) Services for Certain MassHealth Members
  27. § 450.200 - Conflict Between Regulations and Contracts
  28. § 450.201 - Choice of Provider
  29. § 450.202 - Nondiscrimination
  30. § 450.203 - Payment in Full
  31. § 450.204 - Medical Necessity
  32. § 450.205 - Recordkeeping and Disclosure
  33. § 450.206 - Determination of Compliance with Medical Standards
  34. § 450.207 - Utilization Management Program for Acute Inpatient Hospitals
  35. § 450.208 - Utilization Management: Admission Screening for Acute Inpatient Hospitals
  36. § 450.209 - Utilization Management: Prepayment Review for Acute Inpatient Hospitals
  37. § 450.210 - Pay-for-performance Payments: MassHealth Agency Review
  38. § 450.211 - Medicaid Electronic Health Records Incentive Payment Program
  39. § 450.212 - Provider Eligibility: Eligibility Criteria
  40. § 450.213 - Provider Eligibility: Termination of Participation for Ineligibility
  41. § 450.214 - Provider Eligibility: Suspension of Participation Pursuant to United States Department of Health and Human Services Order
  42. § 450.215 - Provider Eligibility: Notification of Potential Changes in Eligibility
  43. § 450.216 - Provider Eligibility: Limitations on Participation
  44. § 450.217 - Provider Eligibility: Ineligibility of Suspended Providers
  45. § 450.221 - Provider Contract: Definitions
  46. § 450.222 - Provider Contract: Application for Contract
  47. § 450.223 - Provider Contract: Execution of Contract
  48. § 450.224 - Provider Contract: Exclusion and Ineligibility of Convicted Parties
  49. § 450.226 - Provider Contract: Issuance of Provider ID/Service Location Numbers
  50. § 450.227 - Provider Contract: Termination or Disapproval
  51. § 450.231 - General Conditions of Payment
  52. § 450.232 - Rates of Payment to In-state Providers
  53. § 450.233 - Rates of Payment to Out-of-state Providers
  54. § 450.234 - Rates of Payment to Chronic Disease, Rehabilitation, or Similar Hospitals with Both Out-of-state Inpatient Facilities and In-state Outpatient Facilities
  55. § 450.235 - Overpayments
  56. § 450.236 - Overpayments: Calculation by Sampling
  57. § 450.237 - Overpayments: Determination
  58. § 450.238 - Sanctions: General
  59. § 450.239 - Sanctions: Calculation of Administrative Fine
  60. § 450.240 - Sanctions: Determination
  61. § 450.241 - Hearings: Claim for an Adjudicatory Hearing
  62. § 450.242 - Hearings: Stay of Suspension or Termination or Provider Service Restriction
  63. § 450.243 - Hearings: Consideration of a Claim for an Adjudicatory Hearing
  64. § 450.244 - Hearings: Authority of the Hearing Officer
  65. § 450.245 - Hearings: Burden of Proof
  66. § 450.246 - Hearings: Procedure
  67. § 450.247 - Hearings: Hearing Officer's Decision
  68. § 450.248 - Medicaid Director's Decision
  69. § 450.249 - Withholding of Payments
  70. § 450.259 - Overpayments Attributable to Rate Adjustments
  71. § 450.260 - Monies Owed by Providers
  72. § 450.261 - Member and Provider Fraud
  73. § 450.271 - Individual Consideration
  74. § 450.275 - Teaching Physicians: Documentation Requirements
  75. § 450.301 - Claims
  76. § 450.302 - Claim Submission
  77. § 450.303 - Prior Authorization
  78. § 450.304 - Claim Submission: Signature Requirement
  79. § 450.307 - Unacceptable Billing Practices
  80. § 450.309 - Time Limitation on Submission of Claims: General Requirements
  81. § 450.313 - Time Limitation on Submission of Claims: Claims for Members with Health Insurance
  82. § 450.314 - Final Deadline for Submission of Claims
  83. § 450.316 - Third-party Liability: Requirements
  84. § 450.317 - Third-party Liability: Payment Limitations on Other Health Insurance Claim Submissions
  85. § 450.318 - Third-party Liability: Payment Limitations on Medicare Crossover Claim Submissions
  86. § 450.321 - Third-party Liability: Waivers
  87. § 450.323 - Appeals of Erroneously Denied or Underpaid Claims
  88. § 450.324 - Payment of Claims
  89. § 450.331 - Billing Agencies

Notes

130 CMR, 130 CMR 450.000
Amended by Mass Register Issue 1341, eff. 6/16/2017.

REGULATORY AUTHORITY

130 CMR 450.000: M.G.L. c. 118E, §§ 7 and 12.

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