New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 500 - DEVELOPMENTAL SERVICES
Part He-M 504 - PROVIDER AND PROVIDER AGENCY OPERATIONS
Section He-M 504.05 - Payment for Services

Universal Citation: NH Admin Rules He-M 504.05

Current through Register No. 40, October 3, 2024

(a) Provider agencies shall submit all initial claims to the MMIS, so that the claims are received within 90 days after the date of service on the claim.

(b) If a provider agency has submitted a claim in compliance with (a) above and it is denied, the provider agency shall resubmit the claim within 15 months from the earliest date of service if the provider agency still wishes to receive reimbursement.

(c) Submission of claims in accordance with (a) and (b) above shall constitute the provider agency's assurance that:

(1) The service was delivered in compliance with all applicable federal and state rules and requirements in effect on the date the service(s) was provided, including but not limited to, the home and community based waiver services, chapter He-M 500, He-W 520, He-W 521, and CFR 455.410;

(2) The provider agency has created and maintained all records necessary in accordance with He-M 503, He-M 517, He-M 522, and He-M 524;

(3) The provider agency is prepared to share records with the department or the department's designee, including area agencies, within 30 days as requested; and

(4) The information included within the claim is accurate and complete.

(d) Provider agencies shall not bill the individual for medicaid covered services, even if medicaid denies the claim, when the individual is eligible for medicaid and approved for the service provided.

(e) Claims submitted by, or payments made to, provider agencies who have not timely billed pursuant to this part shall be subject to denied payment or recovery.

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