Rule 37.34.1936 - PROVIDER REIMBURSEMENT(1) The department will pay providers of ABA services the lesser of: (a) the provider's actual submitted charge for services; or(b) the rate established in the department's Medicaid fee schedule, as adopted in ARM 37.85.106.(2) Claims must be submitted by, or on behalf of, a BCBA licensed by the State of Montana and enrolled as a Montana Medicaid provider.(3) The provider may not: (a) utilize Current Procedural Terminology (CPT) codes not approved by the department; or(b) exceed the authorized units of service in an authorized 180 calendar day timespan.(4) The department may review the medical necessity of services or items at any time, either before or after payment, in accordance with the provisions of ARM 37.85.410. If the department determines that services or items were not medically necessary, or otherwise not in compliance with applicable requirements, the department may deny payment or may recover any overpayment in accordance with applicable requirements.(5) The department may not authorize provider's reimbursement retroactively for failure to submit timely, complete, and required documentation.Mont. Admin. r. 37.34.1936
NEW, 2022 MAR p. 01850, Eff. 9/24/2022AUTH: 53-2-201, 53-6-113, 53-21-703, MCA; IMP: 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-21-701, 53-21-702, MCA