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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