Sec. 44.77.015. Claims for medical services.

326 words·~1 min read·/ak/title-44/chapter-77/44-77-015

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)For the purposes of filing claims for medical services provided under AS 47.07 or AS 47.25.120 — 47.25.300, “promptly,” in AS 44.77.010 (a), means within 12 months after the date of service or as provided in

(b)of this section. Except as provided in

(c)of this section, a claim may not be paid if it is not filed promptly; an inference to the contrary may not be drawn from AS 09.10.053 , AS 09.50.250 — 09.50.300, or AS 37.25.010 .

(b)In accordance with

(a)of this section, a claim may be considered to be filed promptly if

(1)the claim was filed more than 12 months after the date of service because the medical provider had reason to believe that the beneficiary was ineligible for service under AS 47.07 or AS 47.25.120 — 47.25.300;

(2)a court of competent jurisdiction or an administrative hearing officer finds that the beneficiary was eligible for service under AS 47.07 or AS 47.25.120 — 47.25.300 on the date of service; and

(3)the claim is filed within 12 months after the date that the court or administrative finding is rendered. The beneficiary is responsible for notifying the medical provider of the judicial or administrative finding. The department shall make a good faith effort to notify the medical provider of the judicial or administrative finding if the department has reason to believe that services have been provided to the beneficiary.

(c)The commissioner of health may authorize payment to a medical provider of a claim not promptly filed, upon good cause shown.

(d)In this section,

(1)“beneficiary” means a person who is found to be eligible to receive medical services under AS 47.07 or AS 47.25.120 — 47.25.300;

(2)“medical provider” means a person, firm, corporation, association, or institution that, on the date of service, was approved to provide medical assistance, in accordance with regulations adopted by the Department of Health.