Ala. Admin. Code r. 560-X-61-.07

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-61-.07 - Payment Acceptance

(1) Eligible Medicaid recipients are not to be billed for covered services once the recipient has been accepted as a Medicaid patient.

(2) The provider is responsible for any follow-up with the fiscal agent or Medicaid on denied claims.

(3) The recipient is not responsible for any difference between billed charges and Medicaid allowed charges.

(4) The recipient may be billed for non-covered services.

(5) Children's Specialty Clinic Services shall be billed utilizing the standard HCFA-1500 claim format and locally assigned procedure codes. The appropriate ICD-9-CM diagnosis code shall be required.

(6) Claims submitted for which there is no documentation, or for charges in excess or in violation of the provider's contractual agreement, are subject to recoupment by the Agency, and to referral for investigation and possible prosecution for fraud.

Author:

Ala. Admin. Code r. 560-X-61-.07

New Rule: Filed April 8, 1996; effective May 13, 1996.

Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. §447.15.