N.Y. Comp. Codes R. & Regs. tit. 9 § 9800.3

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

Section 9800.3 - Duties of the provider

By enrolling, the provider agrees:

(a) to prepare and to maintain contemporaneous records demonstrating its right to receive payment under the program and to keep, for a period of three years from the date care, services or supplies were furnished, all records necessary to disclose the nature and extent of services furnished and all information regarding claims for payment submitted by, or on behalf of, the provider, and to furnish such records and information, upon request, to the contractor, the panel, executive director, or agents and designees;

(b) to comply with the disclosure requirements with respect to ownership and control interests, significant business transactions and involvement with convicted persons;

(c) to accept payment from the program as payment in full for all covered drugs billed under the program, except where specifically provided in law to the contrary with respect to required copayments;

(d) not to illegally discriminate on the basis of handicap, race, color, religion, national origin, sex or age;

(e) to submit claims for payment only for covered drugs actually furnished and which were provided to eligible persons;

(f) to submit claims on officially authorized claim forms in the manner specified by the contractor in accordance with the standards and procedures for claims submission;

(g) to permit audits, by the persons and agencies denominated in subdivision (a) of this section, of all books and records or, in the discretion of the auditing agency, a sample thereof, relating to services furnished and payments received under the program;

(h) that the information provided in relation to any claim for payment shall be true, accurate and complete; and

(i) to comply with the rules, regulations of the program and official directives of the contractor and the executive director.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 9800.3