Providers
Chapter 11
Section 4.1
Unauthorized Institution: Related Professional
Services
Issue Date: January
26, 1987
Revision:
1.0 POLICY
Otherwise
covered services rendered by an authorized professional provider
who is not employed by or contracted with the institution may be
cost-shared even though the medical services were furnished in an
unauthorized institution for which benefits cannot be extended.
2.0 EXCLUSION
Inpatient
mental health services, partial hospitalization, or any other care
that falls under the waiver of liability provision. For example,
when preauthorization is required as for inpatient mental health
services and partial hospitalization and has not been obtained,
payment may not be made for any of the services, either institutional
or those rendered by an authorized professional provider who is not
employed or contracted with the institution.
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