Iowa Admin. Code r. 441-302.3 - [Effective 7/1/2025] Provider oversight and monitoring
(1)
Provider contracts. To receive payment for services through a
BH-ASO, providers of behavioral health services must have a provider contract
with the BH-ASO. Providers that are eligible to enroll with the Iowa Medicaid
program must also be enrolled as an Iowa Medicaid provider.
(2)
Claim submission.
Providers of behavioral health services will submit claims for services on at
least a monthly basis.
a. Claims for services
rendered for persons eligible for Medicaid will be submitted to the managed
care organization with which the person is enrolled in accordance with the
managed care organization's claim submission policies.
b. Claims for services rendered for persons
not eligible for Medicaid will be submitted to the Iowa Medicaid program
according to the process set by the department for BH-ASO claims and will meet
the following requirements:
(1) Claims will
be submitted electronically on the proper claim forms following the
requirements set forth in rule
441-80.2 (249A).
(2) Claims will follow the time limits for
claim submission set forth in rule
441-80.4
(249A).
(3)
Provider monitoring. A BH-ASO will conduct monitoring
activities to oversee providers of behavioral health services within the
district and monitor the Iowa Medicaid provider sanction list and take the
following actions:
a. For any behavioral
health provider suspended by Medicaid, suspend participation in the BH-ASO
provider network within 30 days.
b.
For any behavioral health provider terminated by Medicaid, terminate
participation in the BH-ASO provider network within 30
days.
Notes
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