Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 200 - General Provider Information
Chapter 3 - Beneficiary Information
Rule 23-200-3.8 - Charges Not Beneficiary's Responsibility
Universal Citation: MS Code of Rules 23-200-3.8
Current through September 24, 2024
A. Providers who have agreed to be Medicaid providers are expected to bill Medicaid for Medicaid covered services and accept Medicaid payment as payment in full.
B. Some charges are not the beneficiary's responsibility and must not be billed to the beneficiary. Those included, but not limited to:
1. The beneficiary may not be
billed for Medicaid covered services except in the following situations:
a) If the person is ineligible; or
b) If person has chosen to receive and agreed
to pay for care not covered by the Medicaid program.
2. The beneficiary may not be held liable for
a claim or portion of a claim when a determination that the services were not
medically necessary is made based on the professional opinion of appropriate
and qualified persons performing peer review of Medicaid cases.
3. The beneficiary may not be held liable for
billed charges above the Medicaid maximum allowable.
4. The beneficiary may not be billed for
claims denied because of provider errors. It is the responsibility of the
provider to file claims in a timely manner, to correct errors, and to provide
essential information necessary to process the Medicaid claim.
5. The beneficiary may not be billed for
claims denied because of errors made by DOM, the fiscal agent, or due to
changes in federal or state mandates.
6. The beneficiary may not be billed for
services denied because a provider failed to request required authorization for
a service or failed to meet procedural requirements.
7. For dual eligibles, the beneficiary may
not be billed for the portion of a claim remaining after Medicare and Medicaid
have paid.
8. The beneficiary may
not be billed for the completion and submission of a Medicaid claim form. If
the provider agrees to accept the patient as a Medicaid beneficiary and agrees
to bill Medicaid for the services rendered, the beneficiary may not be charged
for this billing procedure.
9. The
beneficiary may not be billed for telephone calls or missed/cancelled
appointments.
10. The beneficiary
may not be charged for the cost of copying medical records.
Miss. Code Ann. § 43-13-121; 42 CFR §447.15
Disclaimer: These regulations may not be the most recent version. Mississippi 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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