1. (a) A provider shall receive a service authorization form for each time a service is provided.
2. (b) A provider shall bill the department through NH Bridges for health care services to Medicaid ineligible children and Medicaid ineligible laboratory services via paper claims.

3. (c) For paper claim submissions, a provider shall:

   1. (1) Copy the service authorization for future billings, if the authorized service dates span a date range; and
   2. (2) Forward the completed and signed service authorization to DCYF with an invoice attached.

Source. (See Revision Note at part heading for He-C 6348) #9267, eff 9-20-08; ss by #12127, eff 3-10-17