7 AAC 47.240. Reimbursement of provider

(a) Providers shall submit all claims for payment on invoices prescribed by the division and in accordance with the provisions contained in the division's provider manuals.

(b) Claims for payment must be filed promptly following care. The division may not make payment for services provided more than six months before presentation of the claim.

(c) Except as provided in (d) of this section, payment will be made in the amount determined under the provisions of 7 AAC 43. For those services not covered by Medicaid, the division will furnish providers with information for those services covered exclusively under the General Relief Medical program.

(d) The division of medical assistance will reimburse a health facility for services covered under this chapter at 28.7 percent of the facility's Medicaid rate set by the executive director of the Medicaid Rate Advisory Commission under 7 AAC 43.701. The division of medical assistance will deduct the amount owed by the recipient under 7 AAC 47.220 from the amount of payment made to the health facility.

(e) Payment provided by the division represents full and total reimbursement for those covered services authorized under General Relief Medical assistance. By accepting reimbursement from the division of medical assistance, the provider of medical care or medically related services agrees not to charge the recipient for any difference between the amount billed and the amount received in payment from the division of medical assistance, except charges for which the recipient is responsible under 7 AAC 47.220(b) . If the hospital was aware at the time of admission that the patient was a General Relief Medical assistance applicant or recipient, admission of the patient serves as agreement to accept reimbursement from the division of medical assistance as full payment for hospital services. A recipient is responsible for payment of all services not reimbursable under General Relief Medical assistance and for the payments specified in 7 AAC 47.220(b) .

History: Eff. 3/23/78, Register 65; am 5/2/79, Register 70; am 11/28/86, Register 100; am 9/9/95, Register 135

Authority: AS 47.05.010

AS 47.25.170

AS 47.25.195

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