The Pharmacy Manual contains the regulations and administrative and billing instructions for pharmacies. The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 114.3 CMR 31.00.
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.
Each part of the Pharmacy 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
- Pharmacy Regulations (PDF) file size 1MB
Subchapter 5: Administrative and Billing Instructions
Important Note: Pharmacies participating in MassHealth should refer to the POPS Billing Guide for billing instructions. For instructions for electronic billing, refer to the MassHealth Companion Guides.
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.