SECTION 355.8561. Billing

(a) Claims. To be paid, the transportation provider must complete and submit documentation as specified by the Texas Department of Health (department) to the regional medical transportation manager or designee, after department-authorized services have been provided. The department determines whether the provider submits claims electronically or manually. The medical transportation manager or designee receives all requests for payment from the provider. If a provider has any outstanding debts with the State of Texas, he will not be reimbursed until the debt is resolved.

(b) Usual and customary charges. The provider must not bill the department at a unit rate that exceeds the provider's customary charges to the general public for equivalent services.

(c) Individual provider reimbursement. Individual providers are reimbursed for an authorized round trip from the city where the client resides to the city where the medical provider is located. If the individual provider transports a client to a medical provider within the same city, the individual provider submits mileage based on his vehicle's odometer reading for a round trip from the client's residence to the medical provider. If a client lives in a rural location, the individual provider's odometer reading to and from the city nearest the client's residence will be added to the distance between cities. Mileage is computed by Medical Transportation Program (MTP) staff. The mileage reimbursement rate will be the vehicle mile rate set by the legislature for state employees.

Source Note: The provisions of this §355.8561 adopted to be effective November 15, 1992, 17 TexReg 7460; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; amended to be effective December 7, 1995, 20 TexReg 9852; transferred effective September 1, 1997, as published in the Texas Register December 11, 1998, 23 TexReg 12660