N.H. Admin. Code § He-C 6340.10

Current through Register No. 50, December 12, 2024

Section He-C 6340.10 - Billing Process for Adoptive Report Writing Services

(a) "Service Authorization" Form 2110 (6/30/2008) shall be requested by the DCYF case manager.

(b) The provider shall submit to the department a completed "Service Authorization" Form 2110 (6/30/2008) signed and dated by the provider and the authorized individual.

(c) Providers shall bill the department through NH Bridges via paper claims or electronic claims submission solely for actual hours worked.

(d) Providers shall access web account at least every 90 days or the account will be deactivated.

(e) Providers shall notify DCYF when a user no longer requires access to the application;

(f) All invoices and billing submitted shall:

(1) Be completed in accordance with He-C 6340.10;

(2) Be true and accurate;

(3) Be subject to recovery by DHHS if determined to be inaccurate or fraudulent; and

(4) If submitted via web-billing, shall be submitted with the provider's agreement that:

a. The information obtained via the provider web-billing application remains confidential and is used solely for the purposes of administering DCYF services; and

b. The provider is responsible for his or her employee's use of the provider web-billing application.

(g) For paper claim submission, a provider shall:

(1) Copy the "Service Authorization" Form 2110 (6/30/2008) for future billings if the authorized service dates span a date range;

(2) Forward the completed and signed "Service Authorization" Form 2110 (6/30/2008) to DHHS for adoptive history report which includes a certification that the service was provided as specified and that the service claimed is an original claim; and

(3) Attach an invoice with the provider's original signature to the "Service Authorization" Form 2110 (6/30/2008) that details dates and the number of hours spent on the report.

(h) For electronic claims submission, a provider shall:

(1) Request a web billing account from DHHS by completing, signing, and submitting Form 2679 "Provider Web Billing User Account Request Form" (November 2016);

(2) Be issued a log on and a personal identification number (PIN) by DHHS for use in accessing the web billing account; and

(3) Select the recipient(s) and timeframe(s) for which they wish to submit claims from their list of approved service authorizations.

(i) The handwritten signature in (g) above or personal identification number (PIN) if web billing pursuant to (h) above shall be submitted to DHHS and shall certify that:

(1) The billing was completed in accordance with this section;

(2) The invoice includes only those hours for which services were provided;

(3) The billing is true and accurate;

(4) Any payment made for inaccurate or fraudulent billing will be recovered by DHHS;

(5) If web-billing, that information obtained via the provider web billing application is confidential and can be used solely for the purposes of administering DCYF services;

(6) The provider shall notify DCYF when a user no longer requires access to the application;

(7) The provider is responsible for their employee's use of the provider web billing application; and

(8) The provider understands that he or she must access web account at least every 90 days or the account will be deactivated.

N.H. Admin. Code § He-C 6340.10

(See Revision Note at part heading for He-C 6340) #9264, eff 9-20-08

Amended by Volume XXXVII Number 2, Filed January 12, 2017, Proposed by #12059, Effective 12/6/2016, Expires 12/6/2026.