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