Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 482 - NEBRASKA MEDICAID MANAGED CARE
Chapter 5 - THE DENTAL BENEFITS PACKAGE
Section 482-5-009 - PAYMENT FOR SERVICES
Current through September 17, 2024
The Department pays the Dental Benefits Manager a capitated payment for the services it provides. The Department pays a monthly capitation fee to the Dental Benefits Manager for each enrolled member. The monthly capitation fee includes payment for all services in the dental benefits package.
009.01 CAPITATION RATES. The capitation payment rates are actuarially determined and are based on the member's age. The Department may adjust rates when it is determined appropriate.
009.02 PAYMENT IN FULL. Payment to the Dental Benefits Manager is payment in full for all services included in the dental benefits package. The Dental Benefits Manager must not request additional payment from the Department or a member.
009.03 RECOUPMENTS AND RECONCILIATION. When the Department incorrectly makes a payment to the Dental Benefits Manager, the Department must recoup those payments from the Dental Benefits Manager. The Dental Benefits Manager must work with the Department to identify the discrepancy and must allow the Department to recoup and reconcile such payments.
