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101. Mass. Code Regs. 613.07. - Reporting Requirements

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Reporting Requirements
This section establishes the reporting requirements to the Health Safety Net Office from providers seeking payment for an Eligible Service. Providers must maintain records documenting claims for Eligible Services to Low Income Patients, Emergency Bad Debt services, and Medical Hardship services. Providers must make available in general any information the Health Safety Net Office deems necessary to verify that a service is an Eligible Service. If provider fails to comply the Health Safety Net Office may deny payment.  The Health Safety Net Office will pay only for claims that are submitted within the timeframes listed in 114.6 CMR 13.07(2)(a) through (f). Claims must be submitted within 90 days from the date of service or the date of the primary insurer’s explanation of benefits. Hospitals’ claims for Eligible Services must a site-specific Identification Number as assigned by the Health Safety Net Office.  Hospitals must also maintain the following data and make available to the Health Safety Net Office if requested: interim data on revenues and costs to monitor compliance with federal Upper Limit and Safety Net Care payment limits, including Gross and Net Patient Service Revenue for Medicaid non-managed care, Medicaid managed care, and all payers combined; and total patient service expenses for all payers combined. Community Health Centers must maintain patient account records and related reports as set forth in 114.6 CMR 13.03(1)(b)and submit to the Health Safety Net Office if requested. The Health Safety Net Office can adjust claims for services covered by MassHealth, another program of public assistance, or other health insurance plan in which the patient is enrolled. This section also establishes the objection process for an audit adjustment.

Current as of June 2015