Skip Ribbon Commands
Skip to main content

Regulations

:

10.09.36.01, .03, .04, .06, .08, and .09 General Medical Assistance Provider Participation Criteria (Medical Care Programs)

Reg Name

10.09.36.01, .03, .04, .06, .08, and .09 General Medical Assistance Provider Participation Criteria (Medical Care Programs)

Synopsis

​The purpose of this action is to (1) Define the terms “affiliated line of business”, “affiliation”, “claim”, “clean claim”, and “termination” in order to clarify the Program’s requirements for timely filing of claims; 

(2) Clarify the definitions of terms “provider”, “overpayment”, and “withhold payment”; 

(3) Clarify that providers shall register and maintain good standing with the State Department of Assessments and Taxation (SDAT); 

(4) Explain the Program’s policy regarding backdating enrollment effective dates for new providers; 

(5) Centralize existing payment procedures under the general provider payment procedures regulation;

(6) Amend timely filing requirements by eliminating the ability to continuously resubmit claims after initial denial;

(7) Clarify the Department’s ability to recover an overpayment and providers’ ability to appeal an overpayment recovery; 

(8) Codify the Program’s authority to terminate enrollment for lines of business affiliated with for-cause terminated providers;

(9) Explain the effective date of the Program’s action to suspend payment when a credible allegation of fraud is determined; and

(10) Change instances of the term “recipient” to “participant”.


Compliance

10.09.36 Compliance Guide.docx10.09.36 Compliance Guide.docx Compliance Guide

Documents

Printed in Maryland Register

 

End of Comment Period

 

FINAL Printed

 

Type of Adoption

 

Effective Date

 

Attachments

Content Type: Item
Created at 10/30/2019 10:49 AM by System Account
Last modified at 10/30/2019 10:49 AM by System Account