482 Neb. Admin. Code, ch. 5, § 006

Current through June 17, 2024

Section 482-5-006 - COORDINATION OF SERVICES

The following rules apply when coordination of services is required between the physical health plan responsible for the core benefits package and the Dental Benefits Manager responsible for the dental benefits package, as addressed by the Department in regulations governing both components of managed care. In situations where the individual is only a member of a health plan or the Dental Benefits Manager, but not both, the payment of the associated service is coordinated with the Department on a fee-for-service basis.

006.01INPATIENT CARE AND SERVICES. The member's Heritage Health plan will be responsible for reimbursing all inpatient services. The Dental Benefits Manager will not be responsible for reimbursing any inpatient or related services.

006.02ANESTHESIOLOGY ASSOCIATED WITH DENTAL SERVICES. Anesthesiology services associated with dental services, authorized by the Dental Benefits Manager, are the responsibility of the Heritage Health plan if the member is also a member of a health plan.

482 Neb. Admin. Code, ch. 5, § 006

Amended effective 7/29/2020

Amended effective 9/27/2021