Section 470 IAC 11.1-4-2 - Payment of provider claimsAuthority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-16-7-4
Sec. 2.
(a) Upon receipt of the provider's "completed" and "approved" claim, the division or its designee shall pay two-thirds (b) of the "allowed rate" for said claim within a reasonable period after receipt thereof subject to the provisions of subsection (c).(b) An "allowed rate" as used in this rule, means the current rate of reimbursement which a hospital would have received as a Medicaid provider at its "Medicaid interim rate" for having rendered the same service, or that rate of reimbursement which a nonhospital provider would have received as a Medicaid provider for having rendered the same service.(c) In the event that funds allocated to pay claims for a given state fiscal year are insufficient to pay the two-thirds (b) of "completed" and "approved" claims submitted for that state fiscal year, the department's liability for further payment hereunder is limited to the provisions of IC 12-16-7-4(b).(d) In the event that there are funds available at the end of each state fiscal year, the department shall, to the extent of such available funds, pay each provider a pro rata portion of the one-third (a) balance on paid claims at the allowed rate. The formula for such year end payments shall be: | Total HCI funds available Total one-third (a) balance | × | Total amount of a provider's unpaid balance | = | Amount paid at fiscal year end to provider |
Division of Family Resources; 470 IAC 11.1-4-2; filed May 25, 1989, 1:45 p.m.: 12 IR 1861; filed Oct 3, 1997, 4:50 p.m.: 21 IR 378; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFAThe numerator shall not exceed the dollar amount represented in the denominator.