| PART 1 - GENERAL INFORMATION |
| 296-23A-0100 | Where can I find general information and rules pertaining to the care of workers? |
| 296-23A-0110 | When will the department or self-insurer pay for hospital services? |
| 296-23A-0120 | What services are subject to review by the department or self-insurer? |
| 296-23A-0130 | How does the department establish hospital payment rates? |
| 296-23A-0140 | How can interested persons request advance notice of changes to hospital payment rates, methods and policies? |
| PART 1.1 - SUBMITTING BILLS |
| 296-23A-0150 | How must hospitals submit bills for hospital services? |
| 296-23A-0160 | How must hospitals submit charges for ambulance and professional services? |
| 296-23A-0170 | How must hospitals bill the department or self-insurer for preadmission services? |
| PART 1.2 - SUPPORTING DOCUMENTATION REQUIREMENTS |
| 296-23A-0180 | What supporting documentation must hospitals send for hospital services? |
| 296-23A-0190 | Where must hospitals send supporting documentation for hospital services for state fund claims? |
| 296-23A-0195 | When must providers using electronic medium submit supporting documentation? |
| PART 2 - PAYMENT METHODS FOR HOSPITAL SERVICES |
| 296-23A-0200 | How does the department pay for hospital inpatient services? |
| 296-23A-0210 | How do self-insurers pay for hospital inpatient services? |
| 296-23A-0220 | How does the department pay for hospital outpatient services? |
| 296-23A-0221 | How does the self-insurer pay for hospital outpatient services? |
| 296-23A-0230 | How does the department or self-insurer pay out-of-state hospitals for hospital services? |
| 296-23A-0240 | How does the department define and pay a new hospital? |
| 296-23A-0250 | Does a change in hospital ownership affect a hospital's payment rate? |
PART 2.1 - PERCENT OF ALLOWED CHARGES (POAC)
PAYMENT METHODS AND POLICIES |
| 296-23A-0300 | When do percent of allowed charges (POAC) payment factors apply? |
| 296-23A-0310 | What is the method for calculating percent of allowed charges (POAC) factors? |
| PART 2.2 - PER DIEM PAYMENT METHODS AND POLICIES |
| 296-23A-0350 | When do per diem rates apply? |
| 296-23A-0360 | What is the method for calculating per diem rates? |
| PART 2.3 - DIAGNOSIS-RELATED-GROUP PAYMENT METHODS AND POLICIES |
| 296-23A-0400 | What is a "diagnosis-related-group" payment system? |
| 296-23A-0410 | How does the department calculate diagnosis-related-group (DRG) relative weights? |
| 296-23A-0420 | How does the department determine the base price for hospital services paid using per case rates? |
| 296-23A-0430 | How does the department calculate a hospital specific case-mix adjusted average cost per case? |
| 296-23A-0440 | How does the department calculate the base price for DRG hospitals, except major teaching hospitals? |
| 296-23A-0450 | What cases does the department exclude from base price calculations? |
| 296-23A-0460 | How does the department calculate the diagnosis-related-group (DRG) per case payment rate for a particular hospital? |
| 296-23A-0470 | Which exclusions and exceptions apply to diagnosis-related-group (DRG) payments for hospital services? |
| 296-23A-0480 | Which hospitals does the department exclude from diagnosis-related-group (DRG) payments? |
| 296-23A-0490 | Which hospital services does the department include in diagnosis-related-group (DRG) rates? |
| 296-23A-0500 | When does a case qualify for high outlier status? |
| 296-23A-0520 | How does the department pay for high outlier cases? |
| 296-23A-0530 | How does a case qualify for low outlier status? |
| 296-23A-0540 | How does the department pay for low outlier cases? |
| 296-23A-0550 | Under what circumstances will the department pay for interim bills? |
| 296-23A-0560 | How does the department define and pay for hospital readmissions? |
| 296-23A-0570 | How does the department define a transfer case? |
| 296-23A-0575 | How does the department pay a transferring hospital for a transfer case? |
| 296-23A-0580 | How does the department pay the receiving hospital for a transfer case? |
| PART 3 - REQUESTING A HOSPITAL RATE ADJUSTMENT |
| 296-23A-0600 | How can a hospital request a rate adjustment? |
| 296-23A-0610 | Where must hospitals submit requests for rate adjustments? |
| 296-23A-0620 | What action will the department take upon receipt of a request for a rate adjustment? |
| PART 4 - AMBULATORY PAYMENT CLASSIFICATION PAYMENT METHODS AND POLICIES |
| 296-23A-0700 | What is the "ambulatory payment classification" (APC) payment system? |
| 296-23A-0710 | Definitions. |
| 296-23A-0720 | How does the department calculate the hospital-specific per APC rate used for paying outpatient services under the outpatient prospective payment system (OPPS)? |
| 296-23A-0730 | How does the department determine the APC relative weights? |
| 296-23A-0740 | How does the department calculate payments for covered outpatient services through the outpatient prospective payment system (OPPS)? |
| 296-23A-0750 | What exclusions and exceptions apply to ambulatory-payment-classification (APC) payments for hospital services? |
| 296-23A-0770 | How will excluded outpatient services and hospitals be paid? |
| 296-23A-0780 | What information needs to be submitted for the hospital to be paid for outpatient services? |