1. (1) Providers should not send recipients bills or statements for covered services once the recipient has been accepted as a Medicaid patient.
2. (2) Providers may send a notice to the recipient stating their claim is still outstanding if the notice indicates in bold letters, "THIS IS NOT A BILL".
3. (3) Providers are responsible for follow-up with the fiscal agent or Medicaid on any billing problems or unpaid claims.
4. (4) Providers agree to accept the amount paid by Medicaid as payment in full.
5. (5) Recipients are not responsible for the difference between charges billed and the amount paid by Medicaid for covered services.
6. (6) Recipients may be billed only for the allowable copayment amount, for services not covered by Medicaid, or when benefits have been exhausted.
7. (7) Providers may not deny services to any eligible recipient due to the recipient's inability to pay the allowable copayment amount.

Author: Medicaid Agency

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§447.50,447.55.

History: Ed. Note: Previous rule "Out-of-State Facilities" effective October 1,1982. Amended effective March 11, 1985. Emergency repeal effective October 15, 1990.Permanent repeal effective January 15, 1991. Amended: Filed September 8, 1998;effective October 13, 1998.