(1) Reimbursement of enrolled providers for mental health services covered under the plan and provided to plan members is as provided in ARM Title 37, chapters 5, 40, 82, 85, 86, and 88 for the same service or category of service under the Montana Medicaid Program, except as otherwise provided in this subchapter.

(a) For services covered under the plan, reimbursement under the plan is subject to the same requirements, restrictions, limitations, rates, fees and other provisions that would apply to the service if it were provided to a Medicaid recipient, except as otherwise provided in these rules. However, if a service is not covered under the plan, the fact that the service is or would be covered by Medicaid if provided to a Medicaid recipient, does not entitle the provider, member or any other person or entity to coverage or reimbursement of the service under the plan.

(i) For purposes of applying Medicaid rules to plan services, a person eligible for the plan under ARM 37.89.106 need not be Medicaid eligible.

(2) Provider claims for mental health services provided to members under the plan must be submitted to the department's Medicaid Management Information System (MMIS) contractor according to requirements set forth in ARM 37.85.406. Payments will be made to the provider through the department's Medicaid MMIS contractor.

(3) Providers must accept the amounts payable under this rule as payment in full for services provided to members. For purposes of this rule, the requirements of ARM 37.85.406 regarding payment in full apply to the provider, except as provided in this subchapter.

(a) Providers may bill a member who fails to show up for a scheduled service if such billing is consistent with a written policy maintained and posted by the provider, if the member has been informed of the policy in writing and if the policy applies equally to private pay patients and members.

(4) The provisions of ARM 37.85.407 apply with respect to third party resources and seeking payment from these sources.