Sec. 10.11.03.13. General Billing Procedures

A. A provider shall accept payment at the Medical Assistance rate as payment in full.

B. A provider shall submit:

(1) Requests for payment on the form designated by the CMS Program; and

(2) Completed reports and attachments as requested by the CMS Program.

C. A provider may not bill the CMS Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by mail or telephone; and

(4) Services which are provided at no charge to the general public.

D. The CMS Program shall:

(1) Make no direct payment to the family;

(2) Pay any claim for services provided on different dates and submitted on a single form, and only if it is received by the CMS Program within 12 months of the earliest date of service; and

(3) Pay a claim which is rejected for payment due to improper completion or incomplete information, only if it is properly completed, resubmitted, and received by the CMS Program within the original 12-month period or within 60 calendar days of rejection, whichever is later.

E. The CMS Program reserves the right to return to the provider, before payment, all:

(1) Invoices not properly signed, completed, and accompanied by properly completed forms as required by the Department, to include any necessary preauthorization forms; and

(2) Claims not properly completed.

F. If payment is denied by the CMS Program due to late billing, the provider may not seek payment from the child’s family.