441—88.73 (249A) Claims payment.
	 88.73(1) Claims payment by contractor. The contractor shall meet the following time lines for the payment of all claims for covered, required and optional mental health and substance abuse services submitted which meet the contractor’s requirements for claim submission:
	  a.   	 For at least 85 percent of claims submitted, payment shall be mailed or claims shall be denied within 14 days of the date the claim is received by the contractor.
	  b.   	 For at least 90 percent of claims submitted, payment shall be mailed or claims shall be denied within 30 days of the date the claim is received by the contractor.
	  c.   	 For 100 percent of claims submitted, payment shall be mailed or claims shall be denied within 90 days of the date the claim is received by the contractor.
	 88.73(2) Limits on payment responsibility for services.
	  a.   	 The contractor is not required to reimburse providers for the provision of mental health services that do not meet the criteria of psychosocial necessity.
	  b.   	 The contractor is not required to reimburse providers for the provision of substance abuse services that do not meet the criteria of service necessity.
	  c.   	 The contractor is not required to reimburse providers for the provision of MR/CMI/DD case management services that do not meet the criteria and requirements set forth in 441—Chapter 90.
	  d.   	 The contractor has the right to require prior authorization of covered, required and optional services and to deny reimbursement to providers who do not comply with such requirements.
	  e.   	 Payment responsibilities for emergency room services are as provided at subrule 88.66(2).
	  f.   	 Payment responsibility for services provided under the “keep kids safe” policy is set forth at subrule 88.67(8).
	 88.73(3) Payment to nonparticipating providers. In reimbursing nonparticipating providers, the contractor is obligated to pay no more than the average rate of reimbursement which the contractor pays to participating providers for the same service.
	 88.73(4) Payment of crossover and copayments. Rescinded IAB 1/9/02, effective 3/1/02.