The Physician Manual contains the regulations, administrative and billing instructions, and service codes for physicians, nurse midwives, independent nurse practitioners, portable X-ray providers, and diagnostic imaging centers. The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 114.3 CMR 16.00, 114.3 CMR 18.00 and 101 CMR 317.00.
Each part of the Physician 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: Physician 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 .