1. (a) Payment for hospital services shall be made at rates established by the department in accordance with RSA 161:4, VI(a).
2. (b) Hospital providers shall submit claims for payment to the department’s fiscal agent using the form currently designated and approved by CMS for this purpose.

3. (c) Hospital providers billing for newborns who do not have their own medicaid identification number shall complete the claim form as follows:

   1. (1) The newborn’s name shall be entered in the patient field;
   2. (2) The medicaid identification number field shall be left blank; and
   3. (3) The mother’s name and medicaid identification number shall be entered in the remarks section.
4. (d) Payment for inpatient hospital services made for acute care days of stay shall be subject to a post-payment review by the department.

5. (e) All outpatient hospital services rendered to a medicaid recipient within 3 calendar days prior to their inpatient admission, with a calendar day beginning at 12:00 AM and ending at 11:59 PM, shall be inclusive of the inpatient payment and not be billed separately, with the exception of:

   1. (1) Prenatal outpatient services; and
   2. (2) Diagnostic and nondiagnostic outpatient services that are unrelated to the recipient’s inpatient hospital admission.

Source. #9324, eff 11-21-08 (from He-W 543.11); ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.13), EXPIRES: 9-20-35