The Acute Outpatient Hospital Manual contains the regulations, billing instructions, and service codes for acute outpatient hospitals. In-state acute outpatient hospitals should also refer to the RFA (Request for Application) signed by the hospital for the current rate year for additional requirements. Acute inpatient hospitals should refer to the Acute Inpatient Hospital Manual.
Each part of the Acute Outpatient Hospital Manual is listed below from beginning to end. You can print each part separately (or any individual pages) or print all parts for a complete manual.
Table of Contents
- Table of contents pages i, ii, ii-a, and iii appear at the beginning of Subchapter 1 below.
- Table of contents page iv appears at the beginning of Subchapter 4 below.
- Table of contents page v (PDF)
- Table of contents page vi (PDF)
Subchapters 1 through 3: Administrative and Billing Regulations
- Administrative and Billing Regulations (apply to all providers) (PDF) file size 1MB file size 1MB
Subchapter 4: Acute Outpatient Hospital Regulations
Subchapter 5: Administrative and Billing Instructions
For instructions for electronic billing, refer to the MassHealth Companion Guides. For instructions for billing MassHealth using paper claim forms refer to MassHealth Billing Guides for Paper Claim Submitters.
The Administrative and Billing Instructions are divided into seven parts.
- Part 1. Eligibility (PDF)
- Part 2. Prior Authorization (PDF)
- Part 3. Billing MassHealth (PDF)
- Part 4. Required Forms and Documentation (PDF)
- Part 5. Claim Status and Payment (PDF)
- Part 6. Claim Status and Correction (PDF)
- Part 7. Other Insurance (PDF)
This information is provided by MassHealth.