Md. Code Regs. 10.09.39.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.39.06 - Payment Procedures

A. The provider shall submit the request for payment in the format designated by the Program.

B. The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.

C. The provider shall charge the Program the provider's customary charge to the general public. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §H of this regulation; and

(2) The provider's reimbursement is not limited to the provider's customary charge.

D. The Program will pay for covered services, the lesser of:

(1) The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(2) The Program's fee schedule.

E. The provider may not bill the Program or the participant for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by mail;

(4) Professional services rendered via telehealth when services are indicated as an exclusion; or

(5) Providing a copy of a participant's medical record when requested by another provider on behalf of the participant.

F. Payments for services rendered to a birthing parent shall be made directly to a qualified provider.

G. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.

H. Reimbursement.

(1) Unless otherwise specified, payments shall be made in 15-minute units of service.

(2) The provider shall be reimbursed in accordance with COMAR 10.09.02.07D.

Md. Code Regs. 10.09.39.06

Regulations .06 adopted as an emergency provision effective July 1, 1989 (16:14 Md. R. 1565); extended at 16:24 Md. R. 2615; adopted permanently effective November 27, 1989 (16:23 Md. R. 2506)
Regulation .06 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 .06 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 .06F amended effective April 4, 2011 (38:7 Md. R. 430); amended effective 43:13 Md. R. 713, eff. 7/4/2016; repealed effective 44:17 Md. R. 834, eff. 8/28/2017; adopted effective 49:4 Md. R. 300, eff. 2/21/2022; amended effective 51:12 Md. R. 618, eff. 6/24/2024.