Section 17b-262-679 - Billing procedure(a) Claims from DME providers shall be submitted on a hard copy invoice or electronically transmitted to the department or its agent, in a form and manner as specified by the department, and shall include all information required by the department to process the claim for payment.(b) Claims submitted for DME not requiring prior authorization shall include the name of the licensed practitioner or clinic making the referral. A licensed practitioner's original prescription for these items shall be on file with the provider and shall be subject to review by the department.(c) DME providers shall bill and the department shall pay at the lowest of: (1) the usual and customary charge to the general public;(2) the lowest Medicare rate;(3) the amount in the applicable fee schedule as published by the department;(4) the amount prior authorized in writing by the department; or(5) the lowest price charged or accepted for the same or substantially similar goods or services by the provider from any person or entity.(d) Notwithstanding the provisions of subsection (c)(5) of this section and subject to the approval of the department, a provider may charge or accept a lesser amount based on a showing by the provider of financial hardship to an individual without affecting the amount paid by the department for the same or substantially similar goods or services.Conn. Agencies Regs. § 17b-262-679
Adopted effective August 22, 2000