Idaho Admin. Code r. 16.03.09.230, General Payment Procedures

Permits Idaho Medicaid recipients to obtain care from the participating provider of their choice. Requires providers to submit Medicaid claims to the Department of Health and Welfare. Tasks the Department with processing claims and paying providers. Permits the Department, the US Department of Health and Human Services, and the Bureau of Audits and Investigations to access provider records relevant to reviewing the propriety of claims and identifies the grounds for conducting such review (e.g., necessity of care, fraudulent billing practices, excess charges, etc.). Establishes standards regarding payment amounts and payments for Medicare eligible Medicaid participants.