Sec. 10.20.01.09. Payment Procedures

A. A provider shall submit the request for Program payment for services rendered to a recipient according to procedures established by the Program and in the form designated by the Program.

B. The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.

C. Billing Time Limits.

(1) The Program may not make payments for an invoice that the Program receives more than 6 months from the date of service, except for an invoice first submitted to Medicare, a health insurer, or other third party for reimbursement.

(2) For an invoice initially submitted to a third party for payment, the Program may not make payment unless the Program receives the invoice within 6 months of the date of service or 3 months of the third party's notification of payment action to the provider, whichever is later.

(3) The Program shall make payment on a claim which the Program returns to the provider due to improper completion or incomplete information only if the claim is properly completed, resubmitted, and received by the Program within the original 6 months, or within 3 months of being returned, whichever is later.

(4) If Medicare, or a third party rejects a provider’s claim because the claim was not received within the third party’s billing time limits, the Program may not make payment on that claim.

(5) If the Program denies payment due to late billing, a provider may not recover the amount later from either the recipient or the Department.