14 CRR-NY 635-12.5NY-CRR
STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 14. DEPARTMENT OF MENTAL HYGIENE
CHAPTER XIV. OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
PART 635. GENERAL QUALITY CONTROL AND ADMINISTRATIVE REQUIREMENTS APPLICABLE TO PROGRAMS, SERVICES OR FACILITIES FUNDED OR CERTIFIED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
SUBPART 635-12. LIABILITY FOR SERVICES
14 CRR-NY 635-12.5
14 CRR-NY 635-12.5
635-12.5 Billing, collection and assignment of unpaid amounts.
(a) This section applies to all services, whether or not they are preexisting services.
(b) If the individual does not have full Medicaid coverage, the provider shall bill the individual and/or other liable parties for the services in accordance with the applicable fee schedule in section 635-12.9 of this Subpart or with the reduced fee established by the provider with the approval of OPWDD. However, if the fee has been waived by the provider with the approval of OPWDD, the provider is not required to bill the individual or other liable parties for the Service.
(c) The provider must present the bill no later than 30 days after the month in which the provider rendered the services.
(d) The provider shall make reasonable efforts to collect unpaid bills.
(e) Collection efforts cannot interfere with the individual's services.
(f) After making reasonable collection efforts and upon consent of OPWDD, a provider shall assign to OPWDD its claim for payment for any unpaid amount.
(g) Any payments received by the State for unpaid claims assigned pursuant to this section shall be paid to the provider, minus any State funds paid to the provider pursuant to section 635-12.8 of this Subpart.
14 CRR-NY 635-12.5
Current through June 30, 2021
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IMPORTANT NOTE REGARDING CONTENT CURRENCY: The "Current through" date indicated immediately above is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Administrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of NYS Rules.