<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.39.06" title_num="10" subtitle_num="09" chapter_num="39" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>The provider shall submit the request for payment in the format designated by the Program.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The provider shall charge the Program the provider's customary charge to the general public. If the service is free to individuals not covered by Medicaid:</text>
    <paragraph num="(1)">
      <text>The provider:</text>
      <paragraph num="(a)">
        <text>May charge the Program; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall be reimbursed in accordance with §H of this regulation; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider's reimbursement is not limited to the provider's customary charge.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Program will pay for covered services, the lesser of:</text>
    <paragraph num="(1)">
      <text>The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Program's fee schedule.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The provider may not bill the Program or the participant for:</text>
    <paragraph num="(1)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Professional services rendered by mail;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Professional services rendered via telehealth when services are indicated as an exclusion; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing a copy of a participant's medical record when requested by another provider on behalf of the participant.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Payments for services rendered to a birthing parent shall be made directly to a qualified provider.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Reimbursement.</text>
    <paragraph num="(1)">
      <text>Unless otherwise specified, payments shall be made in 15-minute units of service.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider shall be reimbursed in accordance with COMAR 10.09.02.07D.</text>
    </paragraph>
  </paragraph>
</regulation>