Sec. 10.11.03.11. General Conditions of Provider Participation  


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  • A. A provider of services which are covered by the CMS Program shall comply with the following general requirements:

    (1) For fee for service reimbursement, be approved by Medical Assistance in writing as a Medical Assistance provider;

    (2) For copay and deductible reimbursement, be a participating provider with the insurance plan purchased by the CMS Program for the family;

    (3) Request preauthorization on the forms designated by the CMS Program;

    (4) Adhere to administrative procedures that are established by the CMS Program for the specific treatment services; and

    (5) Maintain adequate records, including prescriptions, for a minimum of 6 years, and make them available upon request to the Department or the Department's designee.

    B. The approval referenced in §A(1) of this regulation shall specify, at a minimum, the following:

    (1) Approved services which may be provided; and

    (2) Duration of approval status.