114.6. Mass. Code Regs. 11.03. - Reporting Requirements

“Reporting Requirements”
 
This law establishes the reporting requirements for each provider, surcharge payer, and ambulatory surgical center.  Providers must submit electronic medical claims information for all Eligible Services. In addition, patient level data should be available to the Division, upon request, for patients for whom they have submitted a claim for Eligible Services. This data includes cost data, patient diagnoses and types of Eligible Services provided, patient demographics write-off amounts, unique patient identifiers, and other data that enables the Division to calculate settlements on a case-by-case basis. The Division can modify these reporting requirements through an administrative bulletin. Any provider, third party surcharge payer, or health center that that fails to comply with the reporting requirements faces different penalties. Among them, the Division may deny payment for eligible services and a civil penalty or fine may be established.