Regulation .13 General Billing Procedures.
Regulation .13 General Billing Procedures.LinkCopy Citation
A.
A provider shall accept payment at the Medical Assistance rate as payment in full.
B.
A provider shall submit:
(1)
Requests for payment on the form designated by the CMS Program; and
(2)
Completed reports and attachments as requested by the CMS Program.
C.
A provider may not bill the CMS Program for:
(1)
Completion of forms and reports;
(2)
Broken or missed appointments;
(3)
Professional services rendered by mail or telephone; and
(4)
Services which are provided at no charge to the general public.
D.
The CMS Program shall:
(1)
Make no direct payment to the family;
(2)
Pay any claim for services provided on different dates and submitted on a single form, and only if it is received by the CMS Program within 12 months of the earliest date of service; and
(3)
Pay a claim which is rejected for payment due to improper completion or incomplete information, only if it is properly completed, resubmitted, and received by the CMS Program within the original 12-month period or within 60 calendar days of rejection, whichever is later.
E.
The CMS Program reserves the right to return to the provider, before payment, all:
(1)
Invoices not properly signed, completed, and accompanied by properly completed forms as required by the Department, to include any necessary preauthorization forms; and
(2)
Claims not properly completed.
F.
If payment is denied by the CMS Program due to late billing, the provider may not seek payment from the child’s family.