<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".13" citation="COMAR 10.11.03.13" title_num="10" subtitle_num="11" chapter_num="03" heading="General Billing Procedures.">
  <paragraph num="A.">
    <text>A provider shall accept payment at the Medical Assistance rate as payment in full.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A provider shall submit:</text>
    <paragraph num="(1)">
      <text>Requests for payment on the form designated by the CMS Program; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Completed reports and attachments as requested by the CMS Program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A provider may not bill the CMS Program 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 or telephone; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Services which are provided at no charge to the general public.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The CMS Program shall:</text>
    <paragraph num="(1)">
      <text>Make no direct payment to the family;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The CMS Program reserves the right to return to the provider, before payment, all:</text>
    <paragraph num="(1)">
      <text>Invoices not properly signed, completed, and accompanied by properly completed forms as required by the Department, to include any necessary preauthorization forms; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Claims not properly completed.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>If payment is denied by the CMS Program due to late billing, the provider may not seek payment from the child’s family.</text>
  </paragraph>
</regulation>