Md. Code Regs. 10.09.78.06

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

Section 10.09.78.06 - Payment Procedures

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

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 for similar services.

D. The Program will reimburse a provider for covered services:

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

(2) In accordance with §I of this regulation.

E. 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 §I of this regulation; and

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

F. 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; or

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

G. Payments for services rendered to a Program participant shall be made directly to a qualified provider.

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

I. Effective January 1, 2022, the Program shall reimburse a flat rate of $188 per home visit.

Md. Code Regs. 10.09.78.06

Regulation .06 repealed effective 47:10 Md. R. 515, eff. 5/18/2020; amended effective 49:1 Md. R. 13, eff. 1/13/2022