Claims for Items Priced at Individual Consideration

The MassHealth agency will not accept a quote attached to a claim for orthotics that are identified in 101 CMR 334.00: Prostheses, Prosthetic Devices and Orthotic Devices; the Orthotics and Prosthetics Payment and Guidelines Tool; or in other guidance issued by MassHealth, as requiring individual consideration (I.C.). For items designated as I.C., the provider must: (A) attach the actual manufacturer’s invoice dated within six months of the prior authorization request to the claim submission; (B) not accept a printed invoice or order from a manufacturer’s web site; and (C) keep a copy of the quote and the invoice on file. (130 CMR 442.422 Reserved)