130 CMR, § 420.414

Current through Register 1531, September 27, 2024

Section 420.414 - Recordkeeping Requirements

(A)Record Retention. Federal and state regulations require that all MassHealth providers maintain complete written records of patients who are members. All original records, including original radiographs (physical or electronic), must be kept for a minimum of four years after the date of service. Records for members who are residents of long-term-care facilities must be retained by the dentist as part of the member's dental record and by the nursing facility as part of the member's record at the facility.

(B)Dental Record. Payment by the MassHealth agency for Dental Services listed in 130 CMR 420.000 includes payment for preparation of the member's dental record, including electronic dental records. Services for which payment is claimed must be substantiated by clear evidence of the nature, extent, and necessity of care provided to the member. For all claims under review, the member's medical and dental records determine the appropriateness of services provided to members. The written dental record corresponding to the services claimed must include, but is not limited to:

(1) the member's name, date of birth, and sex;

(2) the member's identification number;

(3) the date of each service;

(4) the name and title of the individual servicing provider furnishing each service, if the dental provider claiming payment is not a solo practitioner;

(5) pertinent findings on examination and in medical history;

(6) a description of any medications administered or prescribed and the dosage given or prescribed;

(7) a description of any anesthetic agent administered, the dosage given, and the anesthesia flowsheet;

(8) a complete identification of treatment including, when applicable, the arch, quadrant, tooth number, and tooth surface;

(9) dated digital or mounted radiographs, if applicable; and

(10) copies of all approved prior authorization requests or the prior authorization number.