# Mass. Gen. Laws ch. 176O, sec. 5B: Policies and procedures to enforce Sec. 5A > Massachusetts · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5B ## Section - **Citation:** Mass. Gen. Laws ch. 176O, sec. 5B - **Heading:** Policies and procedures to enforce Sec. 5A - **Jurisdiction:** Massachusetts - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** MA Code / Part I / Title XXII / Chapter 176O / Section 5B ## Text Section 5B. To ensure uniformity and consistency in the submission and processing of claims for health care services pursuant to section 5A, the bureau of managed care within the division of insurance, after consultation with a statewide advisory committee including, but not limited to, representatives of the Massachusetts Hospital Association, the Massachusetts Medical Society, the Massachusetts Association of Health Plans, the Blue Cross and Blue Shield of Massachusetts, the Massachusetts Health Information Management Association, the Massachusetts Health Data Consortium, a representative of America's Health Insurance Plans, a representative of a MassHealth contracted managed care organization, the executive office of health and human services, the center for health information and analysis, the house of representatives and the senate, shall adopt policies and procedures to enforce said section 5A. The policies and procedures shall include a system for reporting inconsistencies related to a carrier's compliance with said section 5A. The bureau shall work jointly with the executive office of health and human services to resolve reports of noncompliance with the requirements of section 61 of chapter 118E. The bureau shall convene the advisory committee annually to review and discuss issues reported by health care providers pursuant to this section and to discuss further recommendations to improve the uniformity and consistency of the reporting of patient diagnostic information and patient care service and procedure information as it relates to the submission and processing of health care claims. Section 5B. To ensure uniformity and consistency in the submission and processing of claims for health care services pursuant to section 5A, the bureau of managed care within the division of insurance, after consultation with a statewide advisory committee including, but not limited to, representatives of the Massachusetts Hospital Association, the Massachusetts Medical Society, the Massachusetts Association of Health Plans, the Blue Cross and Blue Shield of Massachusetts, the Massachusetts Health Information Management Association, the Massachusetts Health Data Consortium, a representative of America's Health Insurance Plans, a representative of a MassHealth contracted managed care organization, the executive office of health and human services, the center for health information and analysis, the house of representatives and the senate, shall adopt policies and procedures to enforce said section 5A. The policies and procedures shall include a system for reporting inconsistencies related to a carrier's compliance with said section 5A. The bureau shall work jointly with the executive office of health and human services to resolve reports of noncompliance with the requirements of section 61 of chapter 118E. The bureau shall convene the advisory committee annually to review and discuss issues reported by health care providers pursuant to this section and to discuss further recommendations to improve the uniformity and consistency of the reporting of patient diagnostic information and patient care service and procedure information as it relates to the submission and processing of health care claims. ## Nearby sections - [Mass. Gen. Laws ch. 176O, sec. 1 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S1.md) - [Mass. Gen. Laws ch. 176O, sec. 2 Bureau of managed care](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S2.md) - [Mass. Gen. Laws ch. 176O, sec. 3 Complaints against carriers; notice; hearing](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S3.md) - [Mass. Gen. Laws ch. 176O, sec. 4 Refusal of carriers to contract with eligible health, dental or vision care providers solely because providers have practiced good faith advocacy on behalf of patients](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S4.md) - [Mass. Gen. Laws ch. 176O, sec. 5 Contracts; liability](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5.md) - [Mass. Gen. Laws ch. 176O, sec. 5A Acceptance and recognition of information submitted pursuant to current coding standards and guidelines required; use of standardized claim formats](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5A.md) - [Mass. Gen. Laws ch. 176O, sec. 5B Policies and procedures to enforce Sec. 5A](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5B.md) - [Mass. Gen. Laws ch. 176O, sec. 5C Failure of carrier to comply with coding standards and guidelines; notice; penalty](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5C.md) - [Mass. Gen. Laws ch. 176O, sec. 5D Establishment of base fee schedule for evaluation and management services for behavioral health providers](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5D.md) - [Mass. Gen. Laws ch. 176O, sec. 6 Evidence of coverage to be delivered to covered adults by health, dental and vision care providers; contents](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S6.md) - [Mass. Gen. Laws ch. 176O, sec. 7 Information provided by carrier upon enrollment or upon request](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S7.md) - [Mass. Gen. Laws ch. 176O, sec. 8 Failure by carrier to file annual statement; fine](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S8.md) - [Mass. Gen. Laws ch. 176O, sec. 9 Utilization review programs; annual attestations](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S9.md) - [Mass. Gen. Laws ch. 176O, sec. 9A Agreements or contracts between carrier and health care provider prohibited if containing certain provisions](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S9A.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C176O_S5B. Check the current official text before relying on it. Not legal advice.