Mont. Admin. r. 37.34.1936 - PROVIDER REIMBURSEMENT
(1) The
department will pay providers of ABA services the lesser of:
(a) the provider's actual submitted charge
for services; or
(b) the rate
established in the department's Medicaid fee schedule, as adopted in ARM
37.85.106.
(2) Claims must be submitted by, or on behalf
of, a BCBA licensed by the State of Montana and enrolled as a Montana Medicaid
provider.
(3) The provider may not:
(a) utilize Current Procedural Terminology
(CPT) codes not approved by the department; or
(b) exceed the authorized units of service in
an authorized 180 calendar day timespan.
(4) The department may review the medical
necessity of services or items at any time, either before or after payment, in
accordance with the provisions of ARM
37.85.410.
If the department determines that services or items were not medically
necessary, or otherwise not in compliance with applicable requirements, the
department may deny payment or may recover any overpayment in accordance with
applicable requirements.
(5) The
department may not authorize provider's reimbursement retroactively for failure
to submit timely, complete, and required documentation.
Notes
AUTH: 53-2-201, 53-6-113, 53-21-703, MCA; IMP: 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-21-701, 53-21-702, MCA
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