Report Requirements

A general written report or a discharge summary must accompany the claim for payment for any service that is listed in Subchapter 6 of the Urgent Care Clinic Manual as requiring a report or individual consideration (I.C.), or if the code is for an unlisted service. This report must be sufficiently detailed to enable the MassHealth agency to assess the extent and nature of the service. Each urgent care clinic must provide a copy of the medical record of each urgent care visit to the MassHealth member at the end of the urgent care visit or as soon as available and, with the member’s consent, provide a facsimile or electronically transmitted copy of the medical record of the urgent care visit to the member’s primary care provider, if any. Such copies or transmission must be provided at no charge to the member. In the event that the member has a primary care provider, the urgent care clinic shall provide the member with the name and contact information of such primary care provider, in a manner to be prescribed by the MassHealth agency. In the event that the member does not have a primary care provider, the urgent care clinic shall (1) notify the MassHealth agency that the member does not have a primary care provider, using a form that will be prescribed by the MassHealth agency; and (2) provide the member with the names of primary care providers who participate in MassHealth and practice in the member’s municipality of residence or an adjacent municipality, in a manner to be prescribed by the MassHealth agency. (455.408 through 455.412 Reserved)