Report Required with Certain Claims

(A) The provider must submit with the claim for payment, a written description of the service provided in accordance with the requirements described in Subchapter 6 of the Dental Manual when (1) the service description in Subchapter 6 stipulates “by report;” or (2) the service is designated in Subchapter 6 as “IC”. See 130 CMR 420.412. (B) The report must be sufficiently detailed to enable the MassHealth agency to assess the extent and nature of services provided.