Section 86-3.4 - Administrative procedures

86-3.4 Administrative procedures. Implementation of these regulations shall be based on the following:

(a) No written agreement between hospital and HMO is required to initiate and continue this reimbursement methodology.

(b) Upon request by the HMO, a hospital shall furnish documentation of the certified IX-C rate(s) in effect at the hospital, or other approved IX-C reimbursement if per diem is not in use.

(c) Upon receipt of inpatient statements itemizing charges and stating total IX-C reimbursement due to the hospital, the HMO may reimburse the hospital directly. The HMO shall pay such obligations within 30 days of receipt of the statement(s), unless other arrangements are approved by the hospital.

(d) HMO's and hospitals shall mutually furnish administrative and medical data as is customarily required when third parties are involved in the process of hospital admission, discharge and reimbursement.

(e) The HMO is responsible for paying retroactive adjustments to IX-C Medicaid and Medicare rates on the basis of the number of patient days of care utilized when the reimbursement method is the 86-3 IX-C access rate.
 

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