(a) A provider shall not bill or submit a claim to the Department or a fiscal intermediary for Medi-Cal benefits not provided to a Medi-Cal beneficiary.

(b) A dental prosthesis, custom-made eye appliance, custom-made prosthetic applicance, or custom-made orthotic appliance shall be deemed provided after diligent attempts to effect delivery have proved unsuccessful or delivery is impossible due to circumstances beyond the control of the provider. Payment for undelivered appliances shall be limited to 80% of the amount which would have been payable had delivery been accomplished. Undelivered appliances for which claims are submitted and paid shall be retained by the provider for a period not less than one year from the date it was ordered from the fabricating laboratory for purposes of delivery to the beneficiary or the Department on demand. If delivery is made to the patient or a representative of the Department on demand within one year of the date of service, the payment on the original claim can be adjusted to provide a total compensation equal to that which would have been forthcoming had delivery been made on the date of service.

(c) Services provided by a selected substitute provider shall be considered to have been provided by the billing provider if all of the following conditions are met:

(d) A provider shall not bill or submit a claim to the Department or a fiscal intermediary for Medi-Cal covered benefits provided to a Medi-Cal beneficiary: