Section 6866 - Procedures(a) The health assessment provider shall inquire of all persons receiving health assessments under provisions of this subchapter as to the person's entitlement to third-party reimbursement for such services. Where such entitlement exists, it shall be billed as follows: (1) Insurance carriers shall be billed where such entitlement exists.(2) The Department's Child Health and Disability Prevention Program shall be billed, in the manner specified by the program, for health assessments provided to the following persons: (A) Medi-Cal beneficiaries if those services are not reimbursable under (1), above.(B) Persons who are not Medi-Cal beneficiaries and for whom services are not reimbursable under (1), above, but who meet the age and family income criteria specified by the Department's Child Health and Disability Prevention Program.(3) Persons enrolled in prepaid health plans that contract with the Department shall receive CHDP services from the prepaid health plan in which they are enrolled in accordance with the contract existing between the prepaid health plan and the Department.(4) Persons may be billed directly for health assessments which are not reimbursable under (1) or (2), above, or the services may be provided at no cost to the person if the provider chooses.(b) Eligibility for state-subvened health assessments shall be determined by the screening provider prior to the provision of such services.(c) Each provider who bills the Department's Child Health and Disability Prevention Program for health assessments rendered pursuant to the provisions of this subchapter shall accept as total reimbursement for those services the amount reimbursed by the Department, and shall make no additional charges to any individual or to the Department's Child Health and Disability Prevention Program for such services.(d) Providers' reimbursement claims for health assessments rendered under the provisions of this subchapter shall be subject to audit by the State anytime within three years beginning with the year in which the claim was filed.(e) A clinical laboratory may bill the Department's Child Health and Disability Prevention Program for cytologic examinations of gynecologic slides taken during the course of a CHDP health assessment, or other laboratory services resulting from a CHDP health assessment as follows:(1) The clinical laboratory shall accept as total reimbursement for the services rendered the amount reimbursed by the Department, and shall make no additional charge to any individual, provider, or to the Department's Child Health and Disability Prevention Program.(2) Each claim for reimbursement must be accompanied by a legible copy of the CHDP health assessment provider's claim form, the Confidential Screening/Billing Report (PM 160) (revision 10/91), which indicates the name, address, and CHDP provider number of the clinical laboratory that will bill the CHDP program for the examination of gynecologic slides or other laboratory services.(3) Clinical laboratories claims for reimbursement will not be processed for payment without the cross-reference information required in (2) above.Cal. Code Regs. Tit. 17, § 6866
1. Amendment filed 11-28-79 as an emergency; effective upon filing (Register 79, No. 48). A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 3-28-80.
2. Certificate of Compliance filed 3-27-80 (Register 80, No. 13).
3. New subsections (e)-(e)(3) and amendment of NOTE filed 2-23-93; operative 3-25-93 (Register 93, No. 9). Note: Authority cited: Sections 208 and 321, Health and Safety Code. Reference: Section 323.2 (a), Health and Safety Code; and Section 655.6, Business and Professions Code.
1. Amendment filed 11-28-79 as an emergency; effective upon filing (Register 79, No. 48). A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 3-28-80.
2. Certificate of Compliance filed 3-27-80 (Register 80, No. 13).
3. New subsections (e)-(e)(3) and amendment of Note filed 2-23-93; operative 3-25-93 (Register 93, No. 9).