69O-153.004. Disclosure of Agreements

A health care provider shall disclose a pre-provision of services agreement by one of the following methods: (1) Attaching a copy of the agreement to the claim form; (2) Attaching a statement that discloses the agreement and the specific terms thereof; (3) Attaching a copy of the policy which provides for the waiver of all or some portion of a deductible or co-payment for employees of the hospital and others and a representation that the waiver is authorized by the policy as to that provider; (4) Disclosure on the Office’s approved uniform claim form when modified to effectuate such disclosure in a uniform manner as to all claims.