1. (a) Enrollment. To receive payment for CHC services, the individual or entity must be enrolled as a Medicaid provider or enrolled as a CHC provider and be willing to accept electronic funds transfer.
2. (b) Prohibition on balance billing. Providers must agree that payment from CHC will be considered payment in full and the eligible child and his or her family may not be billed the balance.

3. (c) Prior authorization.

   1. (1) All covered services for eligible children must be prior authorized prior to billing.
   2. (2) A request for prior authorization can be submitted through the Medicaid Management Information System portal.
4. (d) Deductibles and coinsurance. For covered services paid for by private insurance, CHC may assist with the deductible or coinsurance amount up to one (1) month of household gross monthly, provided it does not exceed the service limit.

5. (e) Payor of last resort.

   1. (1) CHC will not pay for covered services before all other funding sources have been exhausted.
   2. (2) CHC cannot pay for any service that would be covered by medical insurance, including Medicaid or Medicare.
   3. (3) If it appears that the family or child would be eligible for Medicaid (ARKids, TEFRA, or SSI) or for insurance through the Patient Protection and Affordable Care Act, the family must apply for coverage before they can be eligible for CHC services.
   4. (4) CHC will not cover services for a child who is TEFRA Medicaid eligible but has lost TEFRA Medicaid due to failure to pay the required premium.

Codification Notes: Patient Protection and Affordable Care Act (ACA) was enacted as Pub. L. No. 111-148. "SSI" means Supplemental Security Income. "TEFRA" means the Tax Equity and Fiscal Responsibility Act of 1982, enacted as Pub. L. No. 97-248.