Section 128.350  Provider Reimbursement

a)         Provider participation under this Part shall be subject to enrollment with and approval by the Department to provide health care under 89 Ill. Adm. Code 140.11 and 140.12.

b)         Provider participation under this Part shall be voluntary.

c)         Providers under this Part shall be reimbursed in accordance with the established rates of the Department or other appropriate State agency (as set forth in 89 Ill. Adm. Code 140, 143, 144, 148, 149, 152 and 153; 52 Ill. Adm. Code 132; and 77 Ill. Adm. Code 2090) less co-payments or cost sharing as specified in Section 128.320, regardless of whether the patient share is collected. 

d)         Providers under this Part shall be prohibited from billing veterans covered under Veterans Care for any difference between the charge amount and the amount paid by the Department other than the co-payment amounts specified in Section 128.320.

e)         Providers shall be responsible for refunding to the veteran and spouse co-payments collected in excess of the amounts permitted by this Part.

(Source:  Amended at 36 Ill. Reg. 17062, effective November 26, 2012)