Md. Code Regs. 10.09.13.07

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Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.13.07 - Payment Procedures

A. Payment procedures for this chapter are set forth in COMAR 10.09.36.

B. The Department will authorize payment on Medicare ambulance claims if:

(1) The provider accepts Medicare assignments;

(2) Medicare makes direct payment to the provider;

(3) The services are covered by the Program;

(4) Initial billing is made directly to Medicare according to Medicare guidelines;

(5) Medicare has determined that services were medically justified.

C. The Department will make supplemental payment on Medicare ambulance claims, subject to the following conditions:

(1) Deductible insurance will be paid in full;

(2) Coinsurance will be paid in full.

D. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

Md. Code Regs. 10.09.13.07

Regulation .07 amended effective January 23, 1989 (16:1 Md. R. 70)
Regulation .07D amended effective July 1, 1978 (5:12 Md. R. 968); January 1, 1980 (6:26 Md. R. 2075); July 1, 1980 (7:13 Md. R. 1279)
Regulation .07D amended as an emergency provision effective July 1, 1982 (9:11 Md. R. 1123); adopted permanently effective November 1, 1982 (9:19 Md. R. 1894)
Regulation .07E amended as an emergency provision effective July 1, 1990 (17:15 Md. R. 1850); amended permanently effective November 1, 1990 (17:20 Md. R. 2427)
Regulation .07F amended effective April 9, 1984 (11:7 Md. R. 625)
Regulation .07H amended as an emergency provision effective January 8, 1979 (6:2 Md. R. 72); emergency status extended until June 1, 1979 (6:12 Md. R. 1045); adopted permanently effective June 1, 1979 (6:11 Md. R. 979)
Regulation .07J amended as an emergency provision effective July 1, 1978 (5:14 Md. R. 1131); adopted permanently effective November 3, 1978 (5:22 Md. R. 1673)
Regulation .07J amended effective January 30, 1984 (11:2 Md. R. 113); September 10, 1984 (11:18 Md. R. 1584)
Regulation .07K amended as an emergency provision effective January 28, 1991 (18:3 Md. R. 301); emergency status expired April 8, 1991 (18:9 Md. R. 1004)
Regulation .07K amended as an emergency provision effective April 9, 1991 (18:9 Md. R. 1005); amended permanently effective October 7, 1991 (18:18 Md. R. 2004)
Regulation .07 amended effective July 18, 1994 (21:14 Md. R. 1229)