23 Miss. Code. R. 302-2.8 - Reimbursement
A. The Division of Medicaid reimburses for:
1. Office visits only with the Beneficiary
Health Management (BHM) designated physician,
2. Drugs prescribed only by the BHM
designated physician, by the consultant physician, or by an emergency
department physician, and
3. Drugs
dispensed only by the BHM designated pharmacy provider.
B. The Division of Medicaid requires post
utilization review by the Division of Medicaid or designee for reimbursement to
physician and/or pharmacy provider(s) other than the BHM designated physician
and/or pharmacy provider(s) when:
1.
Emergency care is required and the BHM designated physician and/or pharmacy
provider is not available, or
2.
The BHM designated physician and/or pharmacy provider requires consultation
with another physician and/or pharmacy provider.
C. BHM designated physician and/or pharmacy
providers are required to bill the specified procedure codes if counseling
sessions are provided.
1. The counseling
procedure codes can be billed in conjunction with any other service the BHM
designated physician provides to the beneficiary.
2. Documentation must support billing of the
specified procedure codes by the BHM designated physician and/or pharmacy.
D. The Division of
Medicaid reimburses for inpatient hospitalization for treatment of alcohol
and/or drug abuse when the diagnosis is a substance use disorder diagnosis in
accordance with the most current Diagnostic and Statistical Manual (DSM) of
Mental Disorders and the inpatient hospital stay is prior authorized by the
Division of Medicaid or designee.
Notes
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No prior version found.