Sec. 10.09.45.09. Payment Procedures

A. The Program shall reimburse the provider according to the requirements in this chapter and the fees established under COMAR 10.21.25.

B. Request for Payment.

(1) Requests for payment of mental health case management services shall be submitted by an approved provider according to procedures established by the Department. The Department reserves the right to return to the provider, before payment, all invoices not properly signed and completed.

(2) A provider shall submit a request for payment on the invoice form designated by the Department. A separate invoice shall be submitted for each participant. The completed form shall indicate the:

(a) Date or dates of service;

(b) Participant's name and Medical Assistance number;

(c) Provider's name, location, and provider number; and

(d) Nature, unit or units, and procedure code or codes of covered services provided.

(3) A provider shall bill the Program for the appropriate fee or fees specified in COMAR 10.21.25.

(4) The Program may not make direct payment to recipients.

C. Billing time limitations for services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.

D. Payment shall be made:

(1) Only to a qualified provider for covered services rendered to a participant, as specified in these regulations; and

(2) According to the requirements of this chapter and the fees established in COMAR 10.21.25.

E. The Department may reimburse providers for service delivery beyond the maximum units stated in COMAR 10.21.25 only if pre-authorized by the ASO based on a review of medical necessity.