Iowa Code r. 641-3.21 - Reimbursement of providers
(1) To
receive reimbursement for hearing aids and audiologic services, the provider
must complete a provider information sheet and I-9 form provided by the
department.
(2) The provider must
be a Title XIX provider.
(3)
Reimbursement of hearing aids and audiologic services will be paid directly to
the provider based on Title XIX reimbursement rates.
a. Bills will be adjusted accordingly by the
department prior to payment.
b.
Reimbursement for hearing aids or supplemental hearing devices includes the
costs of shipping and handling.
(4) Hearing aids and audiologic services
funding shall be the payor of last resort.
(5) Payment through this funding source is
considered payment in full for covered services. If a third party liability
(TPL) payment equals or exceeds the Title XIX allowance, no further
reimbursement is provided.
(6) The
provider shall submit bills after an enrollee number is assigned to the
applicant and the audiologic service is provided or hearing aid is
fitted.
(7) The provider shall
submit the following documents:
a. Centers for
Medicare and Medicaid Services Form CMS 1500. Forms will be furnished by the
providers and will include the applicant's enrollee number in the upper
right-hand corner of the form.
b.
Manufacturer's invoice for hearing devices as prescribed by the
department.
c. Applicant's
explanation of benefits or documentation of a telephone contact made by the
provider to the patient's private insurance company including: date of contact,
name of insurance representative, name of insurance company, applicant's policy
number and coverage limitations for hearing evaluations and devices.
Notes
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