# COMAR Title 10 — Maryland Department of Health

## Subtitle 11 — Maternal and Child Health

### Chapter 03 — Children's Medical Services Program

#### Regulation .13 General Billing Procedures.

*COMAR 10.11.03.13*

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.