Regulation .11 General Conditions of Provider Participation.
Regulation .11 General Conditions of Provider Participation.LinkCopy Citation
A.
A provider of services which are covered by the CMS Program shall comply with the following general requirements:
(1)
For fee for service reimbursement, be approved by Medical Assistance in writing as a Medical Assistance provider;
(2)
For copay and deductible reimbursement, be a participating provider with the insurance plan purchased by the CMS Program for the family;
(3)
Request preauthorization on the forms designated by the CMS Program;
(4)
Adhere to administrative procedures that are established by the CMS Program for the specific treatment services; and
(5)
Maintain adequate records, including prescriptions, for a minimum of 6 years, and make them available upon request to the Department or the Department's designee.
B.
The approval referenced in §A(1) of this regulation shall specify, at a minimum, the following:
(1)
Approved services which may be provided; and
(2)
Duration of approval status.