10A ncac 63G .0203       FRAUD: PAYMENT OF CLAIM

(a)  All services billed by licensed eye practitioners and optical providers, institutions and suppliers must be consistent with the services actually performed.

(b)  The Division shall use the Medicaid schedule of benefit payments for services charged the Division.  This schedule is maintained by the Department of Health and Human Services.  Division of Medical Assistance, 1985 Umstead Drive, Raleigh, NC 27603‑2001.  The schedule is incorporated by reference including subsequent amendments and additions.

(c)  Licensed eye practitioners, licensed optical providers, institutions, and suppliers must keep records disclosing the services charged the division for five years.  The division may have access to these records on written request by the division director.


History Note:        Authority G.S. 108‑48; 111‑8; 111‑23; 143B‑157;

Eff. February 1, 1976;

Amended Eff. July 1, 1976; February 19, 1976;

Readopted Eff. November 16, 1977;

Amended Eff. August 1, 2002; April 1, 1990; February 1, 1986;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. November 23, 2015.