23.15.404    PROVIDER BILLING AND REIMBURSEMENT

(1) To be eligible for reimbursement for the covered costs of the forensic rape examination, the medical provider must, within 90 days of performing the examination:

(a) submit the FREPP claim form;

(b) provide a copy of the patient information form;

(c) provide an itemized statement of charges listing current procedural terminology (CPT) codes on a standard health care financing administration (HCFA) form; and

(d) provide copies of all pertinent treatment records.

(2) All billing paperwork should be mailed to the Office of Victim Services, ATTN: FREPP, P.O. Box 201410, 1712 9th Ave., Helena, MT 59620-1410.

History: 46-15-411, MCA; IMP, 46-15-411, MCA; NEW, 2005 MAR p. 2063, Eff. 10/28/05.