Sec. 10.09.46.12. Payment Procedures

A. Request for Payment.

(1) An approved provider, with the exception of a medical day care provider, shall submit requests for payment to BHA or its authorized representative for the services covered under this chapter, according to procedures set forth in COMAR 10.09.36.04 or otherwise established by the Department. Medical day care providers shall submit requests for payment to the Department in accordance with COMAR 10.09.07.08.

(2) The provider shall:

(a) Bill the Department in accordance with the payment methodology specified in §C of this regulation;

(b) Accept payment from the Department as payment in full for the services covered under this chapter and make no additional charge for the covered services to the participant or any other party; and

(c) Submit a request for payment in a manner approved by the Department, which includes the:

(i) Date or dates of service;

(ii) Participant's name and Medicaid number;

(iii) Provider's name, location, and Program identification number;

(iv) Type, procedure code or codes, and unit or units of covered services provided; and

(v) Amount of reimbursement requested.

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

C. Payments.

(1) Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.

(2) The Program shall pay for waiver services according to the fee-for-service schedule set forth in COMAR 10.21.25, with the exception of medical day care services.

(3) The Program shall pay for medical day care services in accordance with COMAR 10.09.07 and the participant's approved plan of care.