Dental Manual

The Dental Manual contains the regulations, administrative and billing instructions, and service codes for dental providers. The Massachusetts Division of Health Care Finance and Policy (DHCFP) establishes rates for MassHealth services.

MassHealth issues transmittal letters to update any part of the provider manual. MassHealth issues provider bulletins to communicate information that is not contained in the provider manual.

Each part of the Dental 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) 

Preface

• Preface for the Dental Manual (PDF) 

Subchapters 1 through 3: Administrative and Billing Regulations

• Administrative and Billing Regulations (apply to all providers) (PDF)  file size 1MB

Subchapter 4

• Dental Program Regulations (PDF) 

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 the MassHealth Dental Program Office Reference Manual.

The Administrative and Billing Instructions are divided into seven parts.

• Part 1. Eligibility (PDF) 
• Part 2. Prior Authorization (PDF)    TEXT 
• 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) 

Subchapter 6

• Dental

Appendix A

• Directory (PDF) 

Appendix B

• Enrollment Centers (PDF)  file size 1MB

Appendix C

• Third-Party-Liability Codes (PDF) 

Appendix D

• Par Index (PDF) 

Appendix G

• Utilization Management Program (PDF) 

Appendix H

• Admission Guidelines (PDF) 

Appendix U

• DPH-Designated Serious Reportable Events That Are Not Provider Preventable Conditions 

Appendix V

• MassHealth Billing Instructions for Provider Preventable Conditions 

Appendix W

• EPSDT Services Medical and Dental Protocols and Periodicity Schedules 

Appendix X

• Family Assistance Copayments and Deductibles (PDF) 

Appendix Y

• EVS Codes/Messages (PDF) 

Appendix Z

• EPSDT / PPHSD Screening Services Codes (PDF) 

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This information is provided by MassHealth.