7 AAC 23.200 - Provider agreement

(a) By providing services or supplies under the program for children with disabilities and billing the department for those services, a provider of services or supplies signifies agreement to cooperate in reports, surveys, or audits conducted by the department, and to comply with the department's regulations governing the program for children with disabilities.

(b) A provider shall retain records necessary to disclose fully to the department the extent of services provided to beneficiaries. The provider shall make information regarding any payment available to the department upon request.

(c) A facility that provides services or supplies under the program for children with disabilities shall allow on-site inspection by authorized representatives of the department.

(d) A provider is responsible for claims submitted or certified by the provider's authorized representative.

(e) A provider's endorsement of a check received from the department, or the endorsement of the provider's agent, certifies that the claim for which the check is payment is true and accurate, unless written notice of an error is sent by the provider to the department within 30 days after the date that the check is negotiated.

(f) The department will not pay a cost of service under the program for children with disabilities unless the provider of the service submits a bill for the service to the department in a timely manner. A provider may not charge a child or the child's parent or guardian for a service authorized by the program for children with disabilities unless the charge is for the family participation amount set by the department under 7 AAC 23.180. For the purposes of this subsection, a bill is submitted in a timely manner if

(1) the provider submits it to the department within six months after the service was terminated; or

(2) the provider submits it to the department within one year after provision of the service was terminated and the bill was first submitted to and rejected by an insurance company or a responsible person other than the program for children with disabilities, the child, the child's relative, or the child's guardian.

(g) A provider may charge, and the department will pay, no more than the following amounts for any supplies or services provided to a child under the program for children with disabilities:

(1) for services other than physician services, the rate set for the supply or service by the Medicaid Rate Commission or, if the Medicaid Rate Commission has not set a rate, the usual and customary charge by the provider to the general public for furnishing comparable supplies or services under comparable circumstances; or

(2) for physician services, the reasonable charge for covered services as described at 7 AAC 43.040, as amended from time to time, and adopted by reference.

(h) If payment is received by the provider from a child, a child's relative, a health insurance company, or any other source, for an authorized service that has been or will be paid for by the department, the provider shall refund or credit to the department all or part of the amount received up to the limit of the department's liability.

(i) Providers shall retain all fiscal, patient care, and related records for patients referred by the department under the program for children with disabilities for seven years following the year in which services were provided, except when the department specifically requests that the provider retain them for a longer period. If a provider sells or transfers a facility or practice, the provider shall require in the transfer agreement that the new owner or operator retain the records, and the new owner or operator shall retain the records, even if the former provider fails to include this provision and even if the facility does not continue to participate in the program. Upon cessation of business, a provider or successor shall request department instructions as to disposition of records.

(j) Whenever possible, a provider shall submit claims to insurance companies and other alternative resources before claiming reimbursement from the department.

(k) The department reserves the right to pay a percentage of usual and customary billing amounts for care outside of Alaska if that is the practice of the Medicaid or Crippled Children's Service agency of that state.

(l) A provider shall notify the department on the department's first working day after the provider provides emergency services under 7 AAC 23.160(d).

Notes

7 AAC 23.200

Eff. 6/28/85, Register 94; am 11/8/98, Register 148

With Register 179, October 2006 and under the authority of AS 44.62.125, the regulations attorney changed obsolete terminology concerning persons with disabilities in conformity with ch. 25, SLA 2006.

Authority:AS 18.05.010

AS 18.05.030

AS 18.05.040