C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-19, subsec. 144-101-II-19.10

Current through 2025-02, January 8, 2025

Subsection 144-101-II-19.10 - REIMBURSEMENT

Reimbursement for covered services shall be the lowest of:

A. The amount listed in Chapter III, Section 19, "Allowances for Home and Community Benefits for the Elderly and Adults with Disabilities" for members authorized for these services;

B. The servicing provider's usual and customary charge; or

C. The fee negotiated between the Waiver Services Provider and providers contracted for Environmental Modifications.

In accordance with Chapter I, it is the responsibility of the provider to seek payment from any other resources (private or group insurance benefits, Workers' Compensation, Medicare, etc.) that are available for payment of a rendered service prior to billing MaineCare. Therefore, a service provider under these HCB is expected to seek payment from sources other than MaineCare that may be available to the member. Providers should document all efforts to collect from a third party.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-19, subsec. 144-101-II-19.10