460 IAC 14.1-28-1 Payment of service providers

Sec. 1. (a) A service provider may not receive payment for vocational rehabilitation services before providing the service. (b) To receive payment for providing vocational rehabilitation services, a service provider must: (1) register in the VR claims payment system; (2) submit claims for payment for services rendered, with supporting documentation, to the VR program through the VR claims payment system; (3) submit claims for payment or requests to waive the deadline to submit claims through the VR claims payment system within ninety (90) days of the date of service; and (4) include written verification of providing the service or good. (c) Claims for payment or waiver requests submitted more than ninety (90) days from the date of service are untimely. (d) Untimely claims for payment are denied, and a service provider may not receive payment for untimely claims unless a waiver to the deadline to submit claims has been granted. (e) A waiver request must be submitted to the VR counselor serving the applicant or participant for whom a claim is being filed. (f) A waiver is granted if: (1) an error or action by the VR program delayed filing of claims for payment; (2) the service provider made reasonable and continuous attempts to resolve the claim problem; (3) the service provider has experienced turnover with the staff directly responsible for submitting claims for payment; or (4) the service provider made reasonable and continuous attempts to first bill and collect from a comparable benefit or service. (g) A service provider may correct and resubmit a claim denied for payment by the VR program. A service provider must resubmit the claim within ten (10) days from the date of denial. (h) A service provider is reimbursed for providing vocational rehabilitation services under the participant's authorization for services at the least cost of the vocational rehabilitation services or the published rate set by the VR program. (i) A service provider is prohibited from receiving reimbursement from the VR program for services not included in a participant's authorization for services. (j) A service provider whose claim was denied may request an impartial due process hearing.