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Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth IMS Health All Provider Bulletin 244 May 2014 TO: All Providers Participating

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What is coverage provided via hospital-determined?

Coverage provided via hospital-determined refers to the type of healthcare services that are determined and covered by the hospital for a patient.

Who is required to file coverage provided via hospital-determined?

The hospital or healthcare facility is required to file coverage provided via hospital-determined on behalf of the patient.

How to fill out coverage provided via hospital-determined?

Coverage provided via hospital-determined is filled out by the hospital administration based on the services provided to the patient.

What is the purpose of coverage provided via hospital-determined?

The purpose of coverage provided via hospital-determined is to document and ensure that the patient receives the necessary medical care and services determined by the hospital.

What information must be reported on coverage provided via hospital-determined?

The information that must be reported on coverage provided via hospital-determined includes the specific medical services provided, dates of service, and any associated costs.

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