10A NCAC 43C .0306. REIMBURSEMENT

(a)  Reimbursement for the provision of outpatient diagnostic, medical consultative services and prescribed medications shall not exceed the Medicaid rate in effect at the time the claim is received by the high risk maternity clinic.

(b)  Reimbursement for patient transportation shall not:

(1)           exceed the state's maximum travel allowance per vehicle mile for expenses of a privately‑owned motor vehicle as established in G.S. 138‑6 or the customary charges of a public conveyance; or

(2)           be made to a patient.

(c)  Reimbursement shall not be made for services which are covered by a third party payor.  Providers must take reasonable measures to determine and subsequently collect the legal liability of third party payors to pay for services provided.  If, after the high risk maternity clinic makes payment for particular services, the provider, the patient, or a person responsible for the patient receives partial or total payment for the services from a third party payor, the person receiving the payment must reimburse the high risk maternity clinic to the extent of the amount received by the person without exceeding the amount of the high risk maternity clinic's prior payment to the provider.

(d)  Payment for services at the Medicaid rate is considered payment in full and the provider shall not bill the patient.

(e)  A claim for payment must be submitted to the high risk maternity clinic within 180 days after completion of the service.  The high risk maternity clinic shall make payment to the provider within 45 days after receipt of a valid claim for payment.

 

History Note:        Authority G.S. 130A‑127;

Eff. July 1, 1988.