Statutes, codes, and regulations
Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICESArticle 1 - MEDICAID PROVIDERS AND SERVICES
Rule 405 IAC 1-11.5 - Reimbursement for Services Performed by Physicians, Limited License Practitioners, and Nonphysician Practitioners
Section 405 IAC 1-11.5-3 - Additional provisions

405 Ind. Admin. Code 1-11.5-3

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Current through October 31, 2024
Section 405 IAC 1-11.5-3 - Additional provisions

Authority: IC 12-15-21-2; IC 12-15-21-3

Affected: IC 4-21.5-3; IC 12-15-13-2

Sec. 3.

(a) Physician reimbursement is subject to all other Medicaid rules not otherwise specifically covered by this section. As an example, the provider of service may not develop or bill Medicaid for charges that are in excess of the usual and customary charges billed for similar services to non-Medicaid payers.
(b) In the event that the provider is dissatisfied with rates issued in accordance with this section and has exhausted all interim review procedures provided in this article, it may seek an administrative appeal under IC 4-21.5-3.

405 IAC 1-11.5-3

Office of the Secretary of Family and Social Services; 405 IAC 1-11.5-3; filed Sep 6, 1994, 3:25 p.m.: 18 IR 89; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA
Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA
Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA
Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA