§ 51488.3. Underpayment Adjustments to Medi-Cal Reviews of Pharmacies and Clinics with Special ...
22 CA ADC § 51488.3Barclays Official California Code of Regulations
22 CCR § 51488.3
§ 51488.3. Underpayment Adjustments to Medi-Cal Reviews of Pharmacies and Clinics with Special Permits.
(a) For the purpose of determining underpayment adjustments to a Medi-Cal recovery action, underpayment shall mean a payment amount within the audit period identified by the pharmacy or clinic with a special permit as being deficient. The underpayment may be due to a billing error made by the pharmacy or clinic with a special permit or an incorrect payment made by the fiscal intermediary for claims submitted within the billing time limits as specified in Section 51008.
(b) The pharmacy or clinic with a special permit shall submit a written statement of findings of underpayment to the Department of Health Services prior to issuance of a demand for payment of identified underpayments. This written statement shall provide specific documentation pursuant to Section 51476 to support the contention of the pharmacy or clinic with a special permit that an underpayment occurred.
Credits
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; and Section 208, Health and Safety Code. Reference: Sections 10722, 14115, 14132, 14170, 14170.1, 14171 and 14172, Welfare and Institutions Code; and Section 4063, Business and Professions Code.
History
1. New section filed 12-2-85; effective thirtieth day thereafter (Register 85, No. 49).
2. Amendment of section heading, text and Note filed 1-6-94; operative 2-7-94 (Register 94, No. 1).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 22, § 51488.3, 22 CA ADC § 51488.3
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