Ohio Admin. Code 3701-10-01

Current through all regulations passed and filed through November 4, 2024

Section 3701-10-01 - Breast and cervical cancer project cost sharing

Women covered by health insurance must meet all applicable eligibility requirements outlined in section 3701.144 of the Revised Code.

(A) Any woman eligible for BCCP services who is covered by health insurance that imposes cost sharing, as defined in section 3923.85 of the Revised Code, of more than zero dollars for services covered by the BCCP program will be eligible for services.

(B) The BCCP-eligible woman must provide documentation of cost sharing which may include the following:

(1) An active insurance card specifying cost sharing limits such as copayments

(2) Documentation regarding health benefits specifying cost sharing which exceeds the amount set forth in paragraph (A) of this rule.

(C) The BCCP-eligible women must receive services scheduled by the regional enrollment agency through a provider who meets the following requirements:

(1) The provider is enrolled in Ohio BCCP as a BCCP provider: and

(2) The provider will accept reimbursement from her health insurance plan.

(D) Once the provider receives reimbursement or an explanation of benefits indicating that a portion or all of the claim will not be paid due to cost sharing, the provider may bill BCCP for the balance, up to the medicare allowable amount. Total reimbursement to the provider may not exceed the medicare allowable rate. Claims will be paid to providers according to the following guidelines:

(1) The woman's insurance plan must be billed for services before BCCP is billed.

(2) The provider or the woman will provide an explanation of benefits from the woman's insurance plan to the regional enrollment agency which documents the amount paid by the woman's health insurance plan.

(3) The provider may bill BCCP for an amount up to the difference between the amount paid by the woman's insurance plan and the medicare allowed rate.

(4) The provider bill will be reviewed by the regional enrollment agency and paid in accordance with the customary process for BCCP medical claims.

Ohio Admin. Code 3701-10-01

Effective: 11/4/2019
Five Year Review (FYR) Dates: 10/25/2024
Promulgated Under: 119.03
Statutory Authority: 3701.144
Rule Amplifies: 3701.144