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November 12, 2024 Clouds | 48°F
The 193rd General Court of the Commonwealth of Massachusetts
  1. General Laws
  2. Part I ADMINISTRATION OF THE GOVERNMENT
  3. Title XXII CORPORATIONS
  4. Chapter 176O HEALTH INSURANCE CONSUMER PROTECTIONS
  5. Section 26 Establishment of standardized processes and procedures for the determination of patient's health benefit plan eligibility at or prior to time of service

Section 26

Section 26: Establishment of standardized processes and procedures for the determination of patient's health benefit plan eligibility at or prior to time of service

Section 26. The commissioner shall establish standardized processes and procedures applicable to all health care providers and payers for the determination of a patient's health benefit plan eligibility at or prior to the time of service. As part of such processes and procedures, the commissioner shall (i) require payers to implement automated approval systems such as decision support software in place of telephone approvals for specific types of services specified by the commissioner and (ii) require establishment of an electronic data exchange to allow providers to determine eligibility at or prior to the point of care.