N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-12.5

Current through Register Vol. 46, No. 45, November 2, 2024

Section 635-12.5 - Billing, collection and assignment of unpaid amounts

(a) This section applies to all services, whether or not they are preexisting services.

(b) If the individual does not have full Medicaid coverage, the provider shall bill the individual and/or other liable parties for the services in accordance with the applicable fee schedule in section 635-12.9 of this Subpart or with the reduced fee established by the provider with the approval of OPWDD. However, if the fee has been waived by the provider with the approval of OPWDD, the provider is not required to bill the individual or other liable parties for the Service.

(c) The provider must present the bill no later than 30 days after the month in which the provider rendered the services.

(d) The provider shall make reasonable efforts to collect unpaid bills.

(e) Collection efforts cannot interfere with the individual's services.

(f) After making reasonable collection efforts and upon consent of OPWDD, a provider shall assign to OPWDD its claim for payment for any unpaid amount.

(g) Any payments received by the State for unpaid claims assigned pursuant to this section shall be paid to the provider, minus any State funds paid to the provider pursuant to section 635-12.8 of this Subpart.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-12.5

Amended New York State Register July 1, 2015/Volume XXXVII, Issue 26, eff. 7/1/2015

Amended New York State Register October 28, 2015/Volume XXXVII, Issue 43, eff. 11/1/2015

Amended New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff. 4/20/2016

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016