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

Current through Register 1525, July 5, 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.