Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 14 - CANCER CONTROL
Chapter 10.14.02 - Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment
Section 10.14.02.17 - Reimbursement
Universal Citation: MD Code Reg 10.14.02.17
Current through Register Vol. 51, No. 19, September 20, 2024
A. The Department shall reimburse a participating health care provider only for a medical service or procedure related to the diagnosis and treatment of breast cancer, cervical cancer, or a precancerous cervical lesion for an eligible patient.
B. The Department shall reimburse a participating health care provider a medical management fee pursuant to Regulation .15 of this chapter.
C. The participating health care provider shall reimburse the Department for an overpayment.
D. Insurance or Other Coverage.
(1) If the patient has insurance or
other coverage, the participating health care provider shall first seek payment
from that source.
(2) The provider
shall submit a copy of the insurance carrier's notice or remittance advice with
the invoice.
(3) If the insurance
carrier provides coverage for a reimbursable procedure or service, the
Department shall pay the deductible and patient contribution amount.
(4) If an insurance carrier rejects the
claim or pays less than the amount of the allowed Medical Assistance Program
rate, the provider may submit a claim to the Department.
(5) The Department shall pay the difference
between what was paid by the insurance carrier and the maximum allowable
Medical Assistance Program rate.
(6) If payment is made by both the Department
and the insurance carrier or other source for the same service, the provider
shall refund to the Department within 60 days of receipt the amount paid by the
Department, or the Department may recoup those funds.
E. The Department may not make a direct payment to the eligible patient.
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