The department will pay for a service only if that service

1. (1) is identified as a covered service in accordance with AS 47.07 and 7 AAC 105 - 7 AAC 160;
2. (2) is provided to an individual who is eligible for Medicaid under 7 AAC 100 on the date of service;
3. (3) is ordered or prescribed by a provider authorized to order or prescribe that service under applicable law;
4. (4) is provided by a person who is enrolled as a Medicaid provider or rendering provider under 7 AAC 105.210, or otherwise eligible to receive payment for services under 7 AAC 105 - 7 AAC 160;
5. (5) is medically necessary as determined by criteria established under 7 AAC 105 - 7 AAC 160 or by the standards of practice applicable to the provider;
6. (6) has received prior authorization from the department, if prior authorization is required under 7 AAC 105 - 7 AAC 160; and
7. (7) is not specifically excluded as a noncovered service under 7 AAC 105 - 7 AAC 160.

(Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040