Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 7 - STANDARDS FOR PAYMENTS › Section R9-22-702 - Charges to Members

Current through Register Vol. 30, No. 28, July 12, 2024
AFor purposes
				of this subsection, the term "member" includes the member's financially
				responsible representative as described under A.R.S. §
									36-2903.01.
BRegistered providers must accept payment
				from the Administration or a contractor as payment in full.
CExcept as provided in subsection (D) a
				registered provider shall not request or collect payment from, refer to a
				collection agency, or report to a credit reporting agency an eligible person or
				a person claiming to be an eligible person.
DAn AHCCCS registered provider may charge,
				submit a claim to, or demand or collect payment from a member:
1 To collect the copayment described in
				R9-22-711;
2 To recover from a member that portion of a
				payment made by a third party to the member for an AHCCCS covered service if
				the member has not transferred the payment to the Administration or the
				contractor as required by the statutory assignment of rights to
				AHCCCS;
3 To obtain payment from a
				member for medical expenses incurred during a period when the member
				intentionally withheld information or intentionally provided inaccurate
				information pertaining to the member's AHCCCS eligibility or enrollment that
				caused payment to the provider to be reduced or denied;
4 For a service that is excluded by statute
				or rule, or provided in an amount that exceeds a limitation in statute or rule,
				if the member signs a document in advance of receiving the service stating that
				the member understands the service is excluded or is subject to a limit and
				that the member will be financially responsible for payment for the excluded
				service or for the services in excess of the limit;
5 When the contractor or the Administration
				has denied authorization for a service if the member signs a document in
				advance of receiving the service stating that the member understands that
				authorization has been denied and that the member will be financially
				responsible for payment for the service;
6 For services requested for a member
				enrolled with a contractor, and rendered by a noncontracting provider under
				circumstances where the member's contractor is not responsible for payment of
				"out of network" services under
				R9-22-705(A),
				if the member signs a document in advance of receiving the service stating that
				the member understands the provider is out of network, that the member's
				contractor is not responsible for payment, and that the member will be
				financially responsible for payment for the excluded service;
7 For services rendered to a person eligible
				for the FESP if the provider submits a claim to the Administration in the
				reasonable belief that the service is for treatment of an emergency medical
				condition and the Administration denies the claim because the service does not
				meet the criteria of
				R9-22-217;
				or
8 If the provider has received
				verification from the Administration that the person was not an eligible person
				on the date of service.