<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.48.01.07" title_num="10" subtitle_num="48" chapter_num="01" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>The provider shall submit the request for payment on the appropriate Medical Assistance Program invoice form.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Department 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 Department.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Providers shall charge the Program their usual and customary charge to the general public for similar services.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The fee schedule for covered services except hospital services shall be the same as is contained in the Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule which is incorporated by reference in COMAR 10.09.02.07D.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The reimbursement rates for all covered hospital services shall be the Health Services Cost Review Commission approved rates less the discount allowed the Medical Assistance Program.</text>
  </paragraph>
  <paragraph num="F.">
    <text>For covered services, the Program shall pay the lower of:</text>
    <paragraph num="(1)">
      <text>The provider's usual and customary charge to the general public for similar services; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The applicable rate described in §D or E of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Supplemental payment on Medicare claims shall be made by the Program subject to the following provisions:</text>
    <paragraph num="(1)">
      <text>Deductible insurance shall be paid in full;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Coinsurance shall be paid in full;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Services not covered by Medicare are payable according to §F of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Payments on Medicare claims shall be authorized if:</text>
    <paragraph num="(1)">
      <text>The provider accepts Medicare assignments;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medicare makes direct payment to the provider;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Services are covered by the Program;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Initial billing is made directly to Medicare according to Medicare guidelines.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>The provider may not bill the Program for:</text>
    <paragraph num="(1)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Professional services rendered by mail or telephone;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Services which are provided at no charge to the general public.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>The Program shall make no direct payment to anyone except providers.</text>
  </paragraph>
  <paragraph num="K.">
    <text>The Program may not reimburse invoices received for payment by the local department of social services more than 90 days after the date of service.</text>
  </paragraph>
  <paragraph num="L.">
    <text>Providers shall bill the Program in the following manner:</text>
    <paragraph num="(1)">
      <text>Claims shall be submitted on appropriate forms;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Claims shall be submitted to the local department of social services and shall be received by that department within 90 days of the date of service;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A claim which is rejected for payment due to improper completion or incomplete information shall be paid only if it is properly completed, resubmitted, and received by the Program within the original 90-day period or within 60 days of the rejection, whichever is later.</text>
    </paragraph>
  </paragraph>
</regulation>