470 IAC 12-1-9 Payment for services

Sec. 9. (a) The rate of payment for the services and materials provided under this rule [470 IAC 12] shall be the same as that applied to Title XIX services and materials pursuant to IC 12-1-7-17 [Repealed by Acts 1984, P.L.80, SECTION 10. See IC 12-1-7-17.1], except that, when an estimate has been provided, and the estimate is lower than either the submitted charge or the Title XIX reimbursement rate (where available), the reimbursement will be in the amount of the estimate. Payment made under this rule [470 IAC 12] shall be considered payment in full. (b) Claims for payment shall be submitted on forms specified by the department. Claims shall be denied if they do not include all the information required by the department, or if they cover services which have not been approved by the department. (c) A provider shall not bill this program more than the usual and customary charge to the provider's private pay customers. (d) The procedure provided in 470 IAC 5-1-3.6 [405 IAC 1-1-5] for recovery of overpayments shall apply to the recovery of overpayments made to providers under this rule [470 IAC 12]. (e) The provisions of 470 IAC 5-5-1 [405 IAC 1-5-1] respecting maintenance of records shall apply to providers of covered medical services under this rule [470 IAC 12].