Division 120
Provider Rules

Rules

407‑120‑0100

407‑120‑0110

407‑120‑0112

Scope and Sequence of Electronic Data Transmission Rules

407‑120‑0114

Provider Enrollment Agreement

407‑120‑0116

Web Portal Submitter

407‑120‑0118

Conduct of Direct Data Entry Using Web Portal

407‑120‑0120

Registration Process — EDI Transactions

407‑120‑0130

Trading Partner as EDI Submitter – EDI Transactions

407‑120‑0140

Trading Partner Agents as EDI Submitters — EDI Transactions

407‑120‑0150

Testing — EDI Transactions

407‑120‑0160

Conduct of Transactions — EDI Transactions

407‑120‑0165

Pharmacy Point of Sale Access

407‑120‑0170

Confidentiality and Security

407‑120‑0180

Record Retention and Audit

407‑120‑0190

Material Changes

407‑120‑0200

Department System Administration

407‑120‑0300

407‑120‑0310

Provider Requirements

407‑120‑0320

Provider Enrollment

407‑120‑0325

Compliance with Federal and State Statutes

407‑120‑0330

Billing Procedures

407‑120‑0340

Claim and PHP Encounter Submission

407‑120‑0350

Payments and Overpayments

407‑120‑0360

Consequences of Non-Compliance and Provider Sanctions

407‑120‑0370

Requirements for Financial, Clinical, and Other Records

407‑120‑0380

Fraud and Abuse

407‑120‑0400

MMIS Replacement Communication Plan

407‑120‑1505

Provider and Contractor Audits, Appeals, and Post Payment Recoveries