Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 11 - MATERNAL AND CHILD HEALTH
Chapter 10.11.03 - Children's Medical Services Program
Section 10.11.03.13 - General Billing Procedures
Universal Citation: MD Code Reg 10.11.03.13
Current through Register Vol. 51, No. 19, September 20, 2024
A. A provider shall accept payment at the Medical Assistance rate as payment in full.
B. A provider shall submit:
(1) Requests for payment on the form
designated by the CMS Program; and
(2) Completed reports and attachments as
requested by the CMS Program.
C. A provider may not bill the CMS Program for:
(1) Completion of forms and
reports;
(2) Broken or missed
appointments;
(3) Professional
services rendered by mail or telephone; and
(4) Services which are provided at no charge
to the general public.
D. The CMS Program shall:
(1) Make no direct payment to the
family;
(2) Pay any claim for
services provided on different dates and submitted on a single form, and only
if it is received by the CMS Program within 12 months of the earliest date of
service; and
(3) Pay a claim which
is rejected for payment due to improper completion or incomplete information,
only if it is properly completed, resubmitted, and received by the CMS Program
within the original 12-month period or within 60 calendar days of rejection,
whichever is later.
E. The CMS Program reserves the right to return to the provider, before payment, all:
(1) Invoices not properly signed,
completed, and accompanied by properly completed forms as required by the
Department, to include any necessary preauthorization forms; and
(2) Claims not properly completed.
F. If payment is denied by the CMS Program due to late billing, the provider may not seek payment from the child's family.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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