Administrative Rules of Montana
Department 20 - CORRECTIONS
Chapter 20.15 - CLINICAL SERVICES
Subchapter 20.15.1 - Payment of Provider Claims at Medicaid Rate for Patients in Department of Corrections Custody
Rule 20.15.102 - A PROVIDER MUST ENROLL IN MEDICAID AND ACCEPT THE MEDICAID REIMBURSEMENT RATE TO RECEIVE PAYMENT BY STATE

(1) To receive payment from the State for health care services provided to an individual identified in 53-6-1312, MCA, a provider must:

(2) A provider who accepts an individual identified in 53-6-1312, MCA, as a patient is agreeing to accept the Medicaid rate as payment in full.

(3) In service settings where an individual identified in 53-6-1312, MCA, is accepted as a patient by a provider who arranges for services by other providers, all providers performing services are deemed to have accepted reimbursement from the State at the Montana Medicaid rates.

(4) A provider may not "balance bill" or seek payment in addition to, or in lieu of, the payment by the State. "Balance bill" means a provider bills the patient, or responsible party, the difference between the amount the state reimburses for services and what the provider chooses to charge.