Section 7.47.240. Reimbursement of provider.

	(a)  Providers shall submit all claims for payment on invoices prescribed by the department and in accordance with the requirements under 7 AAC 105.220 for Medicaid providers.  
	(b)  Claims for payment must be filed promptly following care. The department will not make payment for services provided more than six months before presentation of the claim.  
	(c)  Except as provided in (d) of this section, payment will be made in the amount determined under the provisions of 7 AAC 105 - 7 AAC 160. For those services not covered by Medicaid, the department will furnish providers with information for those services covered exclusively under the General Relief Medical program.  
	(d)  The department will reimburse a  health facility for services covered under this chapter at 28.7 percent of the facility's Medicaid rate set by the department under 7 AAC 150.210. The department will deduct the amount owed by the recipient under 7 AAC 47.220 from the amount of payment made to the health facility.  
	(e)  Payment provided by the department represents full and total reimbursement for those covered services authorized under General Relief Medical assistance. By accepting reimbursement from the department, the provider of medical care or medically related services agrees not to charge the recipient for any difference between the amount billed and the amount received in payment from the department, except charges for which the recipient is responsible under 7 AAC 47.220(b). If the hospital was aware at the time of admission that the patient was a General Relief Medical assistance applicant or recipient, admission of the patient serves as agreement to accept reimbursement from the department as full payment for hospital services. A recipient is responsible for payment of all services not reimbursable under General Relief Medical assistance and for the payments specified in 7 AAC 47.220(b).  

Authorities

47.05.010;47.25.170;47.25.195

Notes

Authority

AS 47.05.010 AS 47.25.170 AS 47.25.195

History

Eff. 3/23/78, Register 65; am 5/2/79, Register 70; am 11/28/86, Register 100; am 9/9/95, Register 135; am 8/25/2010, Register 195