(b)

1. (1) For example, if a provider bills fifty dollars ($50.00) for a service and the insurer pays forty dollars ($40.00), but the Medicaid allowable is thirty-seven dollars ($37.00), Medicaid will not make up the ten-dollar difference between the billed amount and the insurance payment, nor can the provider bill the client for the difference.

2. (2)

   1. (A) If the provider bills fifty dollars ($50.00) and the insurance pays thirty-seven dollars ($37.00) and the Medicaid allowable is forty dollars ($40.00), Medicaid can pay the difference, up to the Medicaid allowable.
   2. (B) In this case, Medicaid pays three dollars ($3.00).
3. (3) In both examples, the provider cannot bill the client for the difference between the Medicaid payment and the billed amount.