Provider Eligibility: Participating Providers

The MassHealth agency pays for services described in 130 CMR 420.000 only to providers of dental services who are participating in MassHealth on the date of service. The participating provider is responsible for the quality of all services for which payment is claimed, the accuracy of such claims, and compliance with all regulations applicable to dental services under MassHealth. To claim payment, the participating provider must be the individual who actually performed the service, except as described in 130 CMR 420.404(A) through (D). (A) A dentist or public health dental hygienist who is a member of a group practice can direct payment to the group practice under the provisions of the MassHealth regulations governing billing intermediaries in 130 CMR 450.000: Administrative and Billing Regulations. The dentist or public health dental hygienist providing the services must be enrolled as an individual provider and must be identified on claims for his or her services. (B) A dental school may claim payment for services provided in its dental clinic. (C) A dental clinic may claim payment for services provided in its dental clinic. (D) A community health center, hospital-licensed health center, or hospital outpatient department may claim payment for services provided in its dental clinic.