Section 482-5-009 - PAYMENT FOR SERVICESThe Department pays the Dental Benefits Manager a capitated payment for the services it provides. The Department pays a monthly capitation fee to the Dental Benefits Manager for each enrolled member. The monthly capitation fee includes payment for all services in the dental benefits package.
009.01CAPITATION RATES. The capitation payment rates are actuarially determined and are based on the member's age. The Department may adjust rates when it is determined appropriate.009.02PAYMENT IN FULL. Payment to the Dental Benefits Manager is payment in full for all services included in the dental benefits package. The Dental Benefits Manager must not request additional payment from the Department or a member. 009.02(A)BILLING THE CLIENT. The Dental Benefits Manager must not bill a member for a coverable service, regardless of circumstances. A provider of a service may only bill the client pursuant to 471 NAC.009.03RECOUPMENTS AND RECONCILIATION. When the Department incorrectly makes a payment to the Dental Benefits Manager, the Department must recoup those payments from the Dental Benefits Manager. The Dental Benefits Manager must work with the Department to identify the discrepancy and must allow the Department to recoup and reconcile such payments.482 Neb. Admin. Code, ch. 5, § 009
Amended effective 7/29/2020Amended effective 9/27/2021