Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59H - Health Care Responsibility Program › Chapter 59H-1 - FLORIDA HEALTH CARE INDIGENCY ELIGIBILITY CERTIFICATION STANDARDS › Section 59H-1.010 - Reimbursement Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) The hospital
				shall use the universal hospital claim form, UB 04/CMS-1450, to submit claims
				to the county for eligible individuals who received covered hospital
				care.
(2) Each county shall
				designate an office or agency that will pay claims. The name, title, address,
				and phone number of the person or county agency, which shall process claims
				under the act shall be provided to the Agency on an annual basis, and when
				modified. The county is responsible for informing the Agency of any changes to
				this information within 30 calendar days of such change. The Agency shall
				provide such information to the participating hospitals and regional referral
				hospitals on an annual and modified basis.
(3) The hospital shall submit the completed
				claim and a copy of the notification of eligibility to the resident county
				office designated to pay claims within 6 months of the date of the notice of
				eligibility. Failure to receive a claim within 6 months may result in rejection
				of the claim at the option of the county.
(4) The county shall reimburse the hospital
				within 90 calendar days of receipt of a claim, unless the claim is disputed
				under the provisions of Chapter 120, F.S. In cases where the patient becomes
				eligible for third party payment, disability benefits or other state or federal
				benefits, the hospital shall reimburse the county for any overpayment by the
				county within 60 calendar days of receipt of such payment from any other
				source. In cases where the hospital has received overpayment on a claim(s), the
				hospital shall reimburse the county for any overpayment within 60 calendar days
				of receipt of such notification. If the due date falls on a weekend or holiday,
				the reimbursement deadline is the next business day. Overpayment is an
				adjustment of charges, including credit balance resulting from a payment made
				by an insurance carrier or another responsible party, duplicate payment,
				reimbursement calculation error (as examined by one or more individuals with
				either the county, hospital or Agency and determined to have been paid in error
				based on the review of documentation supporting the claim), or misapplied
				charges or credits.
(5) In cases
				where payment is made to a hospital for a spend-down provision eligible
				applicant and no third party payor or other government program is involved, the
				total payment to the hospital shall not exceed the Medicaid reimbursement rate,
				or other negotiated rate, minus the applicant's share of cost.
(6) The county shall provide the agency, if
				requested, a copy of the claim for which payment is made or denied, indicating
				disposition and date.
Rulemaking Authority 154.3105 FS. Law Implemented 154.306,
					 154.314 FS.
New 3-29-89, Amended 2-24-92, Formerly 10C-26.010, Amended
					 6-7-00, 8-25-16.