§ 50769. Department Responsibility--Other Health Care Coverage.
22 CA ADC § 50769Barclays Official California Code of Regulations
Barclays California Code of Regulations
Title 22. Social Security
Division 3. Health Care Services
Subdivision 1. California Medical Assistance Program (Refs & Annos)
Chapter 2. Determination of Medi-Cal Eligibility and Share of Cost
Article 15. Other Health Care Coverage and Medicare Buy-in Coverage
22 CCR § 50769
§ 50769. Department Responsibility--Other Health Care Coverage.
(b) The Department's fiscal intermediary shall, as directed by the Department, deny provider claims submitted for beneficiaries who have other health care coverage unless the claim is accomplished by a notice of denial of non-coverage of service, termination of coverage, or partial payment which is less than the Medi-Cal schedule of benefits for the service or benefit provided. A provider of service may submit a copy of the original notice of denial or explanation of benefits letter from the other health care coverage. This notice or letter is valid for a period of one year from the date the service was denied. The notice or letter must be accompanied by a completed Medi-Cal claim form for the same service provided to the beneficiary as indicated on the notice or letter.
Credits
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code, Reference: Sections 14023, 14023.7, 14124.90. Welfare and Institutions Code.
History
1. Repealer and new section filed 6-28-89; operative 7-28-89 (Register 89, No. 28).
This database is current through 6/21/24 Register 2024, No. 25.
Cal. Admin. Code tit. 22, § 50769, 22 CA ADC § 50769
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