§ 108C-4 – (Effective until contingency met see note) Criminal history record checks for certain providers.
108C-4. Criminal history record checks for certain providers. (a) The Department shall conduct criminal history records checks of provider applicants and enrolled providers in accordance with federal law and regulation. (b) The Division shall deny enrollment or terminate the enrollment of a provider where any person with a five percent (5%) or greater direct or […]
§ 108C-5 – Payment suspension and audits utilizing extrapolation.
108C-5. Payment suspension and audits utilizing extrapolation. (a) The Department may suspend payments to a provider in accordance with the requirements and procedures set forth in 42 C.F.R. 455.23. (b) In addition to the procedures for suspending payment set forth at 42 C.F.R. 455.23, the Department may also suspend payment to any provider that (i) […]
§ 108C-5.1 – Post-payment review and recovery audit contracts.
108C-5.1. Post-payment review and recovery audit contracts. The Department shall not pay contingent fees pursuant to any contract with an entity conducting Medicaid post-payment reviews or Recovery Audit Contractor (RAC) audits before all appeal rights have been exhausted. Any contingent fee for Medicaid post-payment reviews or RAC audits shall be calculated as a percentage of […]
§ 108C-6 – Agents, clearinghouses, and alternate payees; registration required.
108C-6. Agents, clearinghouses, and alternate payees; registration required. The Department is authorized to establish a registry of billing agents, clearinghouses, and/or alternate payees that submit claims on behalf of providers and to charge a fee to recover the costs of maintaining the registry in accordance with 42 U.S.C. 1396a(a)(79) and implementing regulations. All billing agents, […]
§ 108C-1 – (Effective until contingency met see note) Scope; applicability of this Chapter.
108C-1. Scope; applicability of this Chapter. This Chapter applies to providers enrolled in Medicaid or Health Choice. (2011-399, s. 1.)
§ 108C-2 – (Effective until contingency met see note) Definitions.
108C-2. Definitions. The following definitions apply in this Chapter: (1) Adverse determination. – A final decision by the Department to deny, terminate, suspend, reduce, or recoup a Medicaid payment or to deny, terminate, or suspend a provider’s or applicant’s participation in the Medical Assistance Program. (2) Applicant. – An individual, partnership, group, association, corporation, institution, […]