Sec. 10.09.14.03. Conditions for Participation  


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  • To participate in the Program, the provider shall:

    A. Apply for participation in the Program using the application form designated by the Department;

    B. Be approved for participation by the Department;

    C. Verify the recipient's eligibility;

    D. Maintain adequate records for a minimum of 6 years and make them available, upon request, to the Department or its designee;

    E. Provide service without regard to race, creed, color, age, sex, national origin, marital status, or physical or mental handicap;

    F. Not knowingly employ an optometrist, optician, or physician to provide services to Medical Assistance patients after that optometrist, optician, or physician has been disqualified from the Program, unless prior approval has been received from the Department.

    G. Accept payment by the Department as payment in full for services rendered and make no additional charge to any person or covered services;

    H. Use first quality materials that meet the criteria established by the Department;

    I. Place no restriction on a recipient's right to select providers of the recipient's choice;

    J. Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the recipient;

    K. Agree that if the Program denies payment due to late billing, the provider may not seek payment from the recipient.