Mont. Admin. R. 37.83.821 - QUALIFIED MEDICARE BENEFICIARIES, PROVIDER REQUIREMENTS
(1) As a condition of participation in the
Montana medicaid program, including the qualified medicare beneficiary program,
all providers of service shall abide by all applicable state and federal
statutes and regulations, including but not limited to federal regulations and
statutes found in Title 42 of the United States Code and the Code of Federal
Regulations governing the medicaid program, and all pertinent Montana statutes
and rules governing licensure and certification.
(2) In addition to the requirements provided
in these rules, a provider of services to a medicaid qualified medicare
beneficiary must comply with the requirements in the following rules:
(a) ARM
37.85.402 concerning provider
requirements, participation and service delivery;
(b) ARM
37.85.406(1)
concerning billing requirements;
(c) ARM
37.85.406(2)
concerning prompt payment of claims and prompt recovery of all payments
erroneously or improperly made to a provider;
(d) ARM
37.85.406(3) and
(4) concerning reimbursement requirements,
payment in full and retroactive payment increases;
(e) ARM
37.85.406(5), (6) and
(7) concerning direct provider payments,
payment rates for out of state providers and governmental billing of
medicaid;
(f) ARM
37.85.407 concerning third party
liability;
(g) ARM
37.85.414 concerning record
keeping, record disclosure and audits; and
(h) ARM
37.85.501 concerning
sanctions.
Notes
Sec. 53-2-201 and 53-6-113, MCA; IMP, Sec. 53-6-101 and 53-6-131, MCA;
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