Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 173 - CONTROL OF COMMUNICABLE DISEASE
Chapter 2 - CARE OF CLIENTS WITH TUBERCULOSIS
Section 173-2-009 - PROVIDER PARTICIPATION AND PAYMENTS

Universal Citation: 173 NE Admin Rules and Regs ch 2 ยง 009

Current through September 17, 2024

To participate in the program, providers must be licensed by the Department or its equivalent in another state. Providers that do not meet these standards are not eligible to participate with the program.

009.01 PAYMENT PROCEDURES. Payments are made in accordance with the standards and payment procedures set out in this chapter. Claims may be approved for payment when ail of the following conditions are met:

(A) The client was approved for participation in the program when the service was provided;

(B) The services provided are for program covered services as described in this chapter; and

(C) No more than 6 months have elapsed from the date of service and when the program is received the claim. If circumstances beyond the entity's or individual's control delayed submittal to the program the program may make payment. The determination of whether the circumstances were beyond the entities or individual's control is at the program's discretion and may be based on documentation submitted by the entity or individual or other information received by the program.

009.02 FAILURE TO COOPERATE IN SECURING THIRD PARTY PAYMENT. The program may deny payment of a claim if the entity or client fails to apply third-party payments to covered services, file necessary claims, or to cooperate in matters necessary to secure payments by insurance or other responsible third-parties.

009.03 REFUNDS. Whenever a provider or client receives a third-party payment after a claim has been paid by the program, the provider or client is to refund the program the full amount of the payment within thirty days. The refund is to be accompanied by a copy of the documentation from the third party-payer.

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