Massachusetts’ Medicaid plan, known as Mass Health, requires all providers to keep complete documentation of the patient’s medical record,1 the provided services, and the patient’s account records, in order to determine the quality and extent of services provided under the program.2   The patient’s medical record must include identifying information and clinical data regarding diagnosis and treatment.3  If a provider fails to provide such documentation, Mass Health is not required to pay the bills for the rendered services.4  Massachusetts law allows the use or disclosure of information from applicants and recipients of medical benefits under Mass Health only when it is directly connected to the administration of the program.5

The state also requires public payers of health care to report certain information.  The Division of Health Care Finance and Policy may require uniform reporting of information from public payers in order to analyze changes in premiums over time, changes in benefits and cost-sharing, and changes in plan cost and utilization.  In addition, public payers may be required to submit claims data, member data and provider data in order to develop and maintain a database of health care claims.6