This regulation governs the billing and claims submission process for Mental Health Rehabilitation Services (MHRS) providers contracting with the DC Department of Behavioral Health. Providers must submit claims through the Department's electronic billing system in accordance with their Human Care Agreement (HCA) and departmental billing policies. Providers are also required to maintain supporting documentation for a minimum of six years to support audits. Reimbursement is subject to the Department's eligibility determination, applicable policies, and availability of appropriated funds.
View official source5304 SUBMISSION OF CLAIM 5304.1 In order for claims to be eligible for reimbursement, the MHRS provider shall: Submit claims through the Department’s electronic billing system pursuant to this chapter, the Department billing policy, and the terms of the HCA between the Department and the MHRS provider; and Complete appropriate documentation to support all claims under its HCA with the Department and shall retain such documentation for a minimum of six (6) years or longer if necessary to ensure the completion of any audit. 5304.2 The Department will reimburse an MHRS provider for a claim that is determined by the Department to be eligible for reimbursement pursuant to the terms of this chapter, applicable Department policies, and the HCA between the Department and the MHRS provider, subject to the availability of appropriated funds. SOURCE: Final Rulemaking published at 61 DCR 3787 (April 11, 2014). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 5304