Md. Code Regs. 10.09.38.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.38.06 - Payment Procedures

A. Request for Payment.

(1) Requests for payment of Healthy Start Program services rendered and completed shall be submitted by an approved provider according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid to the provider.

(2) Requests for payment shall be submitted on the invoice form specified by the Department. A separate invoice shall be submitted for each participant. The completed form shall indicate the:

(a) Date or dates of service;

(b) Participant's name and Medical Assistance number;

(c) Provider's name, location, and provider number; and

(d) Nature, unit or units, and procedure code or codes of covered services provided.

(3) Providers shall bill the Program for the appropriate fee specified in §C of this regulation.

B. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

C. Payments shall be made:

(1) Only to a qualified provider for covered services rendered to a participant, as specified in these regulations;

(2) According to the applicable rate under COMAR 10.09.02 or 10.09.21 for risk assessment-plan of care, and enriched maternity service;

(3) According to methodology described in the memorandum of understanding between the Program and each local health department for risk assessment-plan of care;

(4) For high-risk nutrition counseling as follows:

(a) To federally qualified health centers, according to COMAR 10.09.08.05A;

(b) To each local health department, according to the methodology described in the memorandum of understanding between the Program and each local health department;

(c) To Maryland qualified health centers, according to COMAR 10.09.08.06A; and

(d) To all other eligible providers, according to COMAR 10.09.02.07D.

Md. Code Regs. 10.09.38.06

Regulation .06B amended as an emergency provision effective January 28, 1991 (18:3 Md. R. 301); emergency status expired April 8, 1991 (18:9 Md. R. 1004)
Regulation .06B amended as an emergency provision effective April 9, 1991 (18:9 Md. R. 1005); amended permanently effective October 7, 1991 (18:18 Md. R. 2004)
Regulation .06C amended effective September 3, 1990 (17:17 Md. R. 2080); July 20, 1992 (19:14 Md. R. 1283); June 2, 1997 (24:11 Md. R. 794); November 23, 2006 (33:23 Md. R. 1795)
Regulation .06C amended effective December 27, 2010 (37:26 Md. R. 1787); amended effective 44:4 Md. R. 252, eff. 2/27/2017