Section 467-5-002 - MEDICAL PAYMENTSMedical payments are made to medical providers for authorized services after the Department reviews the billings for compliance with requirements.
002.01BILLING REQUIREMENTS. The Department only considers payment for claims when the following billing requirements are met: 002.01(A)THIRD PARTY. All third party sources must be exhausted before payment may be considered.002.01(B)REQUIRED DETAIL ON CLAIMS. The detail required on claims is dependent upon the type of medical claim being submitted. All medical claims submitted to the Department for payment must be completed in its entirety by the provider. Additional supporting documentation may be requested in order to process the claim. Failure to submit additional documentation timely will result in the claim being denied payment.002.01(C)ACCEPT PAYMENT IN FULL. Medical providers must accept the Department's payment as payment in full. Any balance remaining on a claim after payment has been made cannot be billed to the recipient. If the Department does not make payment due to third party sources paying more than the Department's rate, the remaining balance must not be billed to the recipient. Recipients must not be billed for claims denied by the Department for untimely filing.002.01(D)TIMELY FILING. Medical providers must bill within six months from the date of service for payment to be considered by the Department. Claims received beyond six months from the date of service will be denied.002.01(E)REFUNDS. Medical providers have 45 days to refund any overages or erroneous payments or to show that the refunds have already been made or that the refund requests were made in error.467 Neb. Admin. Code, ch. 5, § 002
Amended effective 5/17/2022