Title: Section 43-1.8 - Provider claim

Effective Date

02/08/1989

PROVIDER CLAIM FOR PAYMENT AND EFFORTS TO DETERMINE AVAILABILITY OF THIRD-PARTY PAYERS

43-1.8 Provider claim.

(a) Providers of tuberculosis health care services may not claim payment from local health officials or the State for amounts which are eligible for payment from any other third-party payer or payers.

(b) For a tuberculosis patient who is a local charge, a provider shall submit to the local health official where the patient resides an itemized claim form for payment for tuberculosis health care services furnished to the patient who does not have full third-party coverage of the claim.

(c) For a State charge who does not have full third-party coverage, a provider shall submit an itemized claim form to the local health official where the patient resides. The health official shall verify the information on the claim form and shall forward the claim to the designee of the State Health Commissioner.

(d) The claim form shall show the charges for each of the services provided and shall deduct all amounts eligible for reimbursement or indemnification by the third-party payers.

(e) The claim form shall include the names of third-party payers or indemnitors who have paid, or are or may be responsible for making payments for part or all of the claim, and the amounts each has paid or is or may be responsible for paying.

(f) A form shall be submitted with a copy maintained by the provider, together with the claim form stating in detail the efforts made to determine whether there is third-party coverage or indemnification available for the claim. The form shall also state the efforts made to claim such reimbursements. If the provider's efforts to determine or obtain third-party reimbursement, as reported in the form are found unsatisfactory by the local health official, the provider shall make additional efforts and shall submit a supplemental form.
 

Volume

VOLUME A-1 (Title 10)

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