4123-6-14 MCO bill submission to bureau.

(A) The MCO shall submit bills electronically to the bureau. The bureau shall review all bills for allowed conditions and allowed claims, and shall pay the MCO for allowed payments after receipt of a proper invoice and after a final adjudication permitting payment for the claim. Upon receipt of payment from the bureau, the MCO shall pay the billing provider within seven days or less, if otherwise agreed by contract between the MCO and the provider.

(B) A provider that bills an MCO for services in expectation of payment from the MCO is responsible for the accuracy of all billing data and information the provider transmits to the MCO. The MCO is responsible for the accuracy of translating billing data received from the provider and the accuracy of transmitting billing data to the bureau that results in payment to the MCO or to the provider.

R.C. 119.032 review dates: 10/27/2004 and 03/01/2009

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.30, 4121.31, 4123.05

Rule Amplifies: 4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates: 2/16/96, 1/15/99