10A NCAC 22G .0605. PAYMENT ASSURANCES

(a)  The state will pay the amounts determined under this plan for each covered service furnished in accordance with the requirements of the State Medicaid Plan, provider participation agreement, and Medicaid policies and procedures.  The payments made under this methodology will not exceed the upper limits as established by 42 C.F.R. 447.325.

(b)  Participation in the program is limited to providers who accept, as payment in full, the amounts paid in accordance with this plan.

(c)  In all circumstances involving third party payment, Medicaid is the payor of last resort.  Any amounts paid by non‑Medicaid sources are deducted in determining Medicaid payment.  For patients with both Medicare and Medicaid coverage, Medicaid payment is limited to the amount of coinsurance related to the services, supplies and equipment covered under the Medicare program.

(d)  Excess payments may be recouped from any provider found to be billing amounts in excess of its customary charges, or costs if charges are nominal.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑55; S. L. 1985, c. 479, s. 86; 42 C.F.R. 440.70;

Eff. October 1, 1987;

Amended Eff. October 1, 1992; May 1, 1990.