Are there special rules for provider reimbursement from the Medical Assistance program under Act 95?
Nothing in Act 95 changes the rules or policies on provider reimbursements in the MA program. MA will use the same Third Party Liability (TPL) rules as it does today and as it does with all other services and with other conditions besides autism. If a child is enrolled in the MA program and the service is medically necessary, the provider must present the claim to the MA program for a determination of secondary MA payment. MA will assess the amount that it will pay on the claim and will provide information to the provider on any additional payment from the MA Program. The amount of the MA payment to the provider, including a zero payment, is considered payment in full and the provider may not seek any additional payment from the family/recipient. Providers must be enrolled in the MA Program to be eligible to receive payment, including private insurance copayments, from the MA program, The MA program will not pick up the copay for and has no jurisdiction over providers who are not enrol
Related Questions
- Do the HIPAA (Health Insurance Portability and Accountability Act) special enrollment rules apply to this situation?
- Are there special rules for provider reimbursement from the Medical Assistance program under The Montana law?
- What is the Medical Provider Forensic Rape Examination ("FRE") Direct Reimbursement Program?
