Utah Admin. Code R414-27-3 - Medicaid Certification Subsequent to CHOW
(1) The Division of Medicaid and Health
Financing (DMHF) may not process an enrollment application for the transferee
until the transferor has voided all claims for services on or after the
effective date of the CHOW.
(2) A
transferor shall settle any outstanding amounts it owes to Medicaid within 30
days of Medicaid enrollment by the transferee. If the transferor fails to
return any outstanding amounts as required in Subsection R414-27-3(2):
(a) The transferor shall be subject to a
penalty of the greater of $50 or 5 percent of the outstanding amount;
(b) Interest shall also be accrued at a rate
of 12 percent annually on any outstanding amount and shall be accrued beginning
on the 31
stday following the effective date of
the CHOW;
(c) DMHF may waive the
imposition of a penalty for good cause.
(3) The transferee shall:
(a) Once a provisional license is issued,
submit the following to the DMHF Provider Enrollment team in a timely manner:
(i) A provider enrollment application; and
(ii) A copy of the provisional
license.
(b) Be enrolled
in Medicaid as a new provider before submitting claims.
(4) If the transferee seeks Medicare
certification and the Medicare certification date is different than the issued
provisional license or Medicaid enrollment effective begin date, then the
Medicaid enrollment date shall be the later of the Medicare certification date
or the provisional license date. If the Medicare certification date is later
than the issued provisional license date, then the transferor may submit
Medicaid claims up to, but not including, the Medicare certification date for
the transferee in accordance with all other applicable regulations.
(5) If the transferee seeks Medicare
certification, the transferee may be enrolled in Medicaid before becoming
Medicare-certified provided the transferee is an approved provider, in
accordance with 42 CFR 455, Subpart E.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) The Division of Medicaid and Health Financing (DMHF) may not process an enrollment application for the transferee until the transferor has voided all claims for services on or after the effective date of the CHOW.
(2) A transferor shall settle any outstanding amounts it owes to Medicaid within 30 days of Medicaid enrollment by the transferee. If the transferor fails to return any outstanding amounts as required in Subsection R414-27-3(2):
(a) The transferor shall be subject to a penalty of the greater of $50 or 5 percent of the outstanding amount;
(b) Interest shall also be accrued at a rate of 12 percent annually on any outstanding amount and shall be accrued beginning on the 31 stday following the effective date of the CHOW;
(c) DMHF may waive the imposition of a penalty for good cause.
(3) The transferee shall:
(a) Once a provisional license is issued, submit the following to the DMHF Provider Enrollment team in a timely manner:
(i) A provider enrollment application; and
(ii) A copy of the provisional license.
(b) Be enrolled in Medicaid as a new provider before submitting claims.
(4) If the transferee seeks Medicare certification and the Medicare certification date is different than the issued provisional license or Medicaid enrollment effective begin date, then the Medicaid enrollment date shall be the later of the Medicare certification date or the provisional license date. If the Medicare certification date is later than the issued provisional license date, then the transferor may submit Medicaid claims up to, but not including, the Medicare certification date for the transferee in accordance with all other applicable regulations.
(5) If the transferee seeks Medicare certification, the transferee may be enrolled in Medicaid before becoming Medicare-certified provided the transferee is an approved provider, in accordance with 42 CFR 455, Subpart E.