Article 6. Eligibility for Payment | Midpage

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California Code of Regulations

Division 3. Health Care Services

Subdivision 1. California Medical Assistance Program

Chapter 3. Health Care Services

Article 6. Eligibility for Payment

Article 6. Eligibility for Payment

State of California

51451Inclusions, Exclusions and Suspensions.51452Violation of Regulations, Administrative Sanctions.51453Recommendation for Suspension.51454Provider Defined.51454.1Provider of Personal Care Services Defined.51455Prior Authorization.51456Signing Treatment Authorization Requests.51457Administrative Action. [Repealed]51458Cause for Suspension.51458.1Cause for Recovery of Provider Overpayments.51458.2Statistical Extrapolation of Medi-Cal Provider Reviews.51459Reinstatement.51460Special Claims Review.51461Orders for Suspension or Placement on Prior Authorization. [Repealed]51463Requests for Hearing. [Repealed]51464When Hearing Not Requested. [Repealed]51465Review by the Director. [Repealed]51466Disclosure of Significant Beneficial Interest.51466.1Significant Beneficial Interest. [Repealed]51467Advertising. [Repealed]51469Decertification. [Repealed]51470Billing for Benefits Provided.51471Seeking Reimbursement from Beneficiaries. [Repealed]51471.1Reimbursements for Program Underpayments.51472Sub-Standard Services.51473Excessive Services.51473.1Referral for Excessive Services.51473.2Services to Children.51474False Advertising. [Repealed]51475Refusal to Render Services. [Repealed]51476Keeping and Availability of Records.51476.1Pharmacy and Clinic with Special Permit Records of Pharmaceutical Services.51476.2Personal Care Services Records.51477Confidential Beneficiary Information. [Repealed]51478Prohibition of Rebate, Refund, or Discount.51479Change of Order or Prescription.51480Discriminatory Billings.51481Forbidden Conduct.51482Unwarranted Inpatient Discharge.51483Provider Requirements.51483.1Personal Care Provider Requirements.51484Billing for Suspended Provider.51485Submission of False Information.51485.1Civil Money Penalties.51486Medi-Cal Card Labels.51487Examinations of Beneficiaries.51488Pharmaceutical Postservice--Postpayment On-Site Reviews Including Clinics with Special Permits.51488.1Pharmaceutical Recovery Standards Including Clinics with Special Permits.51488.2Statistical Extrapolation for Medi-Cal Pharmacy Reviews. [Repealed]51488.3Underpayment Adjustments to Medi-Cal Reviews of Pharmacies and Clinics with Special Permits.51488.4Adjustments to Medi-Cal Pharmacy and Clinic with a Special Permit Reviews for Unsubmitted Claims.51489Eligibility for Payment for Paramedic Ambulance Services. [Repealed]51490Claim Submission Requirements for Short-Doyle Medi-Cal Providers.51490.1Claim Submission Requirements for Counties and Providers of Drug Medi-Cal Substance Use Disorder Services.51491Local Educational Agency (LEA) Eligibility for Payment.51492Claim Submission Requirements for Targeted Case Management Providers.51492.1Host County Contractual Responsibilities in the Targeted Case Management Program. [Repealed]51492.2Participation Fee Requirements in the Targeted Case Management Program.