Or. Admin. Code § 410-133-0180
Current through Register Vol. 63, No. 12, December 1, 2024
Section 410-133-0180 - Duplication of Service(1) The school medical provider may only bill a Medicaid-covered school-based health service provided by a contracted medically-qualified individual to the Authority when the school medical provider and the contracted medically-qualified individual have previously agreed that the contracted individual shall not bill for the same service.(2) Duplicate billing is not allowed. Reimbursement made as a result of duplicate billing shall be recovered.(3) Duplicate billing occurs when a claim is submitted for a specific school-based health service (SBHS) provided to a child or young adult pursuant to their Individual Plan of Care (IPOC) when the same school-based health service is provided and billed for on the same date of service by another entity.Or. Admin. Code § 410-133-0180
HR 39-1991, f. & cert. ef. 9-16-91; OMAP 38-1999, f. & cert. ef. 10-1-99; OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05; OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.065