470 IAC 12-1-6 Emergency services

Sec. 6. (a) The provider shall be compensated for emergency services if: (1) The services are provided to an eligible individual requiring the treatment of a medical or surgical emergency, the nature of which precludes submission of a request to the SDPW 590 element. (2) The services are provided to an eligible individual whose condition which, though not a bonafide medical or surgical emergency, is such that delay of immediate medical attention would cause deterioration of the patient's condition. This provision does not authorize any service which safely can be delayed pending SDPW 590 element approval of a request. (b) Claims for emergency medical services described in section 6(a)(1) above are exempted from the prior approval provisions of this rule [470 IAC 12], but must be appropriately and clearly identified and certified as such on billing forms. (c) During the normal work week, telephonic requests may be made for services mentioned in section 6(a)(2) of this rule [470 IAC 12], where delay of such services would cause deterioration of the patient's condition or result in unnecessary confinement or expense. For such services required during other than the normal work week, such telephonic requests shall be made on the first state working day following delivery of the service. The procedure for making telephonic requests will be specified by the department, and will include the requirement for follow-up with a formal request. Telephone approval of a service shall not serve as the basis for billing. All telephone approvals must be documented through the formal request process, and the approved documentation used to support any claims resulting from the services.