Section 470 IAC 11.1-4-3 - Payment denials; recovery of overpaymentsAuthority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-16
Sec. 3.
(a) The division shall deny the payment of any claim or seek the recovery of any improper payment on any claim when the provider or the patient has failed to comply with the requirements of IC 12-5-6[IC 12-5 was repealed by P.L. 2-1992, SECTION 897, effective February 14, 1992.], et seq. or any of the rules promulgated thereunder.(b) The division shall also deny the payment of any claim or seek the recovery of any improper payment on any claim where it is shown that either the provider or the patient has failed to comply with 405 IAC 1-1-4 or 405 IAC 1-1-5.(c) The division shall also deny payments if the allocated funds for the hospital care for the indigent program are insufficient to meet the otherwise allowed rate as defined in section 2(b) of this rule.(d) In the event that the division denies a provider's claim, said claim will be returned to the provider within a reasonable period after receipt thereof with an explanation of the reasons for its denial. Division of Family Resources; 470 IAC 11.1-4-3; 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-470130306RFA