Or. Admin. R. 410-133-0180 - Duplication of Service

Current through Register Vol. 60, No. 12, December 1, 2021

(1) The School Medical (SM) provider that utilizes a contractor to provide health services may only bill Oregon Health Authority or the Division of Medical Assistance Programs (Division) for health services when the school medical (SM) provider and the contracted provider have previously agreed that the contractor will not also bill for the same service.

(2) Duplicate billings are not allowed and payments will be recovered. Billings for health services to Medicaid-eligible students will be considered as duplicate if the same services are billed by more than one Educational Agency (EA) to address the same need. For example: an Education Service District (ESD) and a local school district cannot both bill the same services provided to the student.

(3) A unit of service can only be billed once; under one procedure code, under one provider number.

Notes

Or. Admin. R. 410-133-0180

HR 39-1991, f. & cert. ef. 9-16-91; OMAP 38-1999, f. & cert. ef. 10-1-99; OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05; OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065