SECTION 317:50-1-16. Billing procedures for Medically Fragile Waiver services

(a)   Billing procedures for long-term care medical services are contained in the OKMMIS Billing and Procedure Manual. Questions regarding billing procedures which cannot be resolved through a study of the manual should be referred to the OHCA.

(b)   The approved Medically Fragile Waiver service plan is the basis for the MMIS service prior authorization, specifying:

(1)   service;

(2)   service provider;

(3)   units authorized; and

(4)   begin and end dates of service authorization.

(c)   As part of Medically Fragile Waiver quality assurance, provider audits are used to evaluate whether paid claims are consistent with service plan authorizations and documentation of service provision. Evidence of paid claims that are not supported by service plan authorization and/or documentation of service provision will be turned over to the OHCA Provider Audit Unit for follow-up investigation.

[Source: Added at 27 Ok Reg 2769, eff 8-1-10 (emergency); Added at 28 Ok Reg 1589, eff 6-25-11; Amended at 33 Ok Reg 924, eff 9-1-16]