Unacceptable Billing Practices

(A) No provider may claim payment in a way that may result in payment that exceeds the maximum allowable amount payable for such service under the applicable payment method. (B) Without limiting the generality of 130 CMR 450.307(A), the following billing practices are forbidden: (1) duplicate billing, which includes the submission of multiple claims for the same service, for the same member, by the same provider or multiple providers; (2) overstating or misrepresenting services, including submitting separate claims for services or procedures provided as components of a more comprehensive service for which a single rate of payment is established; and (3) submitting claims under an individual practitioner's provider ID/service location number for services for which the practitioner is otherwise entitled to compensation. (130 CMR 450.308 Reserved) 3. Billing Regulations (130 CMR 450.000)