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130 C.M.R. 450.000 – Administrative and Billing Regulations | Midpage
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Code of Massachusetts Regulations (CMR)
Title 130
Chapter 450.000
130 C.M.R. 450.000
Administrative and Billing Regulations
M.G.L. c. 118E, s. 7 M.G.L. c. 118E, s. 12
MassHealth
450.101
Definitions
450.102
Purpose of 130 CMR 400.000 through 499.000
450.103
Promulgation of Regulations
450.105
Coverage Types
450.106
Emergency Aid to the Elderly, Disabled and Children Program
450.107
Eligible Members and the MassHealth Card
450.108
Selective Contracting
450.109
Out-of-state Services
450.110
Hospital-determined Presumptive Eligibility
450.112
Advance Directives
450.117
Managed Care
450.118
Primary Care Clinician (PCC) Plan
450.119
Primary Care ACOs
450.123
Managed Care Compliance with Mental Health Parity
450.124
Behavioral Health Services
450.130
Copayments Required by the MassHealth Agency
450.140
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services: Introduction
450.141
EPSDT Services: Definitions
450.142
EPSDT Services: Medical Protocol and Periodicity Schedule and Dental Protocol and
450.143
EPSDT Services: Description of Medical Protocol and Periodicity Schedule Visits (EPSDT
450.144
EPSDT Services: Diagnosis and Treatment
450.145
EPSDT Services: Claims for Visits
450.146
EPSDT Services: Claims for Laboratory Services, Audiometric Hearing Tests, Vision Tests,
450.148
EPSDT Services: Payment for Transportation
450.149
EPSDT Services: Recordkeeping Requirements
450.150
Preventive Pediatric Health-care Screening and Diagnosis (PPHSD) Services for Certain MassHealth Members
450.200
Conflict between Regulations and Contracts
450.201
Choice of Provider
450.202
Nondiscrimination
450.203
Payment in Full
450.204
Medical Necessity
450.205
Recordkeeping and Disclosure
450.206
Determination of Compliance with Medical Standards
450.207
Utilization Management Program for Acute Inpatient Hospitals
450.208
Utilization Management: Admission Screening for Acute Inpatient Hospitals
450.209
Utilization Management: Prepayment Review for Acute Inpatient Hospitals
450.210
Pay-for-performance Payments: MassHealth Agency Review
450.211
Medicaid Electronic Health Records Incentive Payment Program: Reconsideration and Appeals Process
450.212
Provider Eligibility: Eligibility Criteria
450.213
Provider Eligibility: Termination of Participation for Ineligibility
450.214
Provider Eligibility: Suspension of Participation Pursuant to United States Department of
450.215
Provider Eligibility: Notification of Potential Changes in Eligibility
450.216
Provider Eligibility: Limitations on Participation
450.217
Provider Eligibility: Ineligibility of Suspended Providers
450.221
Provider Contract: Definitions
450.222
Provider Contract: Application for Contract
450.223
Provider Contract: Execution of Contract
450.224
Provider Contract: Exclusion and Ineligibility of Convicted Parties
450.226
Provider Contract: Issuance of Provider ID/Service Location Numbers
450.227
Provider Contract: Termination or Disapproval
450.231
General Conditions of Payments
450.233
Rates of Payment to Out-of-state Providers
450.234
Rates of Payment to Chronic Disease, Rehabilitation, or Similar Hospitals with Both Out-of- state Inpatient Facilities and In-state Outpatient Facilities.
450.235
Overpayments
450.236
Overpayments: Calculation by Sampling
450.237
Overpayments: Determination
450.238
Sanctions: General
450.239
Sanctions: Calculation of Administrative Fine
450.240
Sanctions: Determination
450.241
Hearings: Claim for an Adjudicatory Hearing
450.242
Hearings: Stay of Suspension or Termination or Provider Service Restriction
450.243
Hearings: Consideration of a Claim for an Adjudicatory Hearing
450.244
Hearings: Authority of the Hearing Officer
450.245
Hearings: Burden of Proof
450.246
Hearings: Procedure
450.247
Hearings: Hearing Officer's Decision
450.248
Medicaid Director's Decision
450.249
Withholding of Payments
450.259
Overpayments Attributable to Rate Adjustments
450.260
Monies Owed by Providers
450.261
Member and Provider Fraud
450.271
Individual Consideration
450.275
Teaching Physicians: Documentation Requirements
450.301
Claims
450.302
Claim Submission
450.303
Prior Authorization
450.304
Claim Submission: Signature Requirement
450.307
Unacceptable Billing Practices
450.309
Time Limitation on Submission of Claims: General Requirements
450.313
Time Limitation on Submission of Claims: Claims for Members with Health Insurance
450.314
Final Deadline for Submission of Claims
450.316
Third-party Liability: Requirements
450.317
Third-party Liability: Payment Limitations on Other Health Insurance Claim Submissions
450.318
Third-party Liability: Payment Limitations on Medicare Crossover Claim Submissions
450.321
Third-party Liability: Waivers
450.323
Appeals of Erroneously Denied or Underpaid Claims
450.324
Payment of Claims
450.331
Billing Agents