The Personal Care Manual contains the regulations, administrative and billing instructions, and service codes for personal care agencies. The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 101 CMR 309.00.
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.
Personal care management agencies and fiscal intermediaries are contracted providers with MassHealth. Applicants may apply to be PCM providers through COMMBUYS Resource Center . Fiscal intermediary contracts are closed.
Each part of the Personal Care 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 ContentsTable 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
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.