Cal. Code Regs. Tit. 22, § 51488.4 - Adjustments to Medi-Cal Pharmacy and Clinic with a Special Permit Reviews for Unsubmitted Claims

(a) Valid claims as defined in Section 51488.3(e), which have inadvertently not been submitted for payment, shall be submitted to the fiscal intermediary for adjudication and shall be credited toward the amount of any overpayment due the Department of Health Services as a result of an onsite review.

(b) The pharmacy or clinic with a special permit shall submit specific written documentation pursuant to Section 51476 to support the contention that the previously unsubmitted claim is a valid claim. The documentation shall be submitted to the Department of Health Services prior to issuance of a demand for payment of identified overpayments.

(c) No review may be reopened to provide for underpayments in which a final decision has been reached pursuant to Section 14171 of the Welfare and Institutions Code.

Notes

Cal. Code Regs. Tit. 22, § 51488.4

1. New section filed 12-2-85; effective thirtieth day thereafter (Register 85, No. 49).
2. Amendment of section heading, subsection (b) and NOTE filed 1-6-94; operative 2-7-94 (Register 94, No. 1).

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; and Section 208, Health and Safety Code. Reference: Sections 10722, 14115, 14132, 14170, 14170.1, 14171 and 14172, Welfare and Institutions Code; and section 4063, Business and Professions Code.

1. New section filed 12-2-85; effective thirtieth day thereafter (Register 85, No. 49).
2. Amendment of section heading, subsection (b) and Note filed 1-6-94; operative 2-7-94 (Register 94, No. 1).