Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 21 - MENTAL HYGIENE REGULATIONS
Chapter 10.21.15 - Petition for Emergency Evaluation-Payment for Services
Section 10.21.15.05 - Billing Procedures
Universal Citation: MD Code Reg 10.21.15.05
Current through Register Vol. 51, No. 19, September 20, 2024
A. The provider shall submit the following documents:
(1) A request for payment on a form
designated by the Department;
(2) A
bill that specifies the:
(a) Name of the
emergency evaluee,
(b) Date of
service, and
(c) Description of
service;
(3) A copy of
the current petition for emergency evaluation;
(4) If the bill is for an examination by a
consultant physician, a copy of the consultant physician's evaluation that is
signed by the examining consultant physician;
(5) If the bill is for transportation of an
emergency evaluee from a designated emergency facility to an inpatient
facility, copies of both completed certificates for involuntary admission and
the application for involuntary admission; and
(6) Any other documentation required by the
Department to determine that the conditions of this chapter have been
met.
B. The provider shall submit the request for payment within 12 months of the date of service.
C. The Department may refuse a request for payment if the request is not accompanied by properly completed forms and documents required under §A of this regulation.
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