Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 442.000 - Orthotics Services
Section 442.423 - Recordkeeping Requirements

Universal Citation: 130 MA Code of Regs 130.442

Current through Register 1531, September 27, 2024

The orthotics provider must keep a record at the service facility for each member for all orthotics and orthotic services provided to a member. The record must include documentation of all purchases and repairs of all orthotics provided for each member in accordance with the recordkeeping requirements set forth in 130 CMR 450.205: Recordkeeping and Disclosure. The orthotics provider must make all records retained in accordance with 130 CMR 450.205 and 130 CMR 442.000 available to the MassHealth agency or its designee upon request. Payment for services is conditioned upon the complete documentation in the member's record. In addition to fulfilling the requirements of 130 CMR 450.205, the provider must ensure that each member's record includes the following:

(A) a copy of the initial order if applicable (or written documentation of a verbal initial order) that meets the requirements set forth in 130 CMR 442.409(A) and a completed, signed, and dated detailed written order that meets the requirements set forth in 130 CMR 442.409(B) and any other applicable state or federal law or regulation;

(B) a copy of each prior authorization request submitted to the MassHealth agency or its designee on behalf of the member, including all related documentation submitted with the request, and all correspondence with the MassHealth agency or its designee and the MassHealth agency decision related to each such request;

(C) if the member has third-party liability, the provider must also maintain a copy of all documentation of their efforts to diligently seek prior authorization and payment from other liable parties;

(D) the actual invoice showing the cost to the provider of the orthotic (if the provider is not the manufacturer of the orthotic); and

(E) an acknowledgement of receipt, signed by the member or the member's representative, of the prescribed orthotics or orthotic service, including:

(1) the date of receipt of the item(s) and location of delivery;

(2) a sufficiently detailed description to identify the item(s) being delivered (such as, brand name, HCPCS code and narrative description);

(3) for repair services, a complete description of the service, including the manufacturer, and if applicable, brand name, model number, and serial number of the repaired item; and

(4) if the member's representative signs, next to the signature, an explanation of the representative's relationship to the member by the individual acknowledging receipt. This individual cannot be associated with the provider.
(a) a signature stamp and/or member's mark may be used by a MassHealth member whose disability inhibits the member's ability to write.

(b) a signature stamp may only be used by a member or the member's representative, provided that the stamp is used by the member in his or her normal course of conducting business. A signature stamp cannot be used by anyone associated with the provider.

(F) documentation demonstrating the cost of manufacturing the orthotic provided, including all raw materials (if the provider is the manufacturer);

(G) for repair services, a complete description of all repair services, including the manufacturer, brand name, and model number of the repaired item;

(H) documentation of a member's other insurance and any documentation submitted to and received from other insurers;

(I) documentation of any oral or written complaints received from the member or submitted on behalf of the member in accordance with 130 CMR 442.405(Q). The documentation must include, at a minimum:

(1) the name, address, and telephone number of the member;

(2) the name, address, and telephone number of the person filing the complaint (if not the member);

(3) a summary of the complaint;

(4) the date the complaint was received by the provider;

(5) the name of the person receiving the complaint; and

(6) a summary of any investigation or actions taken by the provider of orthotics to resolve the complaint.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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