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~~o~, 15 « 383 01 6 <br />thereunder, and policies of the N.C. Medicaid program and applicable <br />OEHNR program rules and regulations. <br />To accept Medicaid covered recipients for care and treatment- <br />vered by <br />2. 3 To provide approved services to eligible in lpc dition bast coregard to <br />race, color, national origin or handicappB <br />Title VI of the Civil Rights Act of 1964 and Section 504 of the <br />Rehabilitation Act of 1973. <br />e of services it will make <br />4 That if it has any restrictions on the typ will accept, or <br />available and/or the type of health conditions acceptance of that per it sons for care and <br />iteria relating to the licable to <br />has any , other cr these restrictions or criteria eria will be app <br />treatment all <br />persons seeking its services. <br />5. To establish and maintain fee schedules for covered services. <br />. To accept paym ent for Medicaid covered services in accordance with the <br />Carolina Secretary and <br />6 <br />rules and regulations for reimburseme the promulgated d North the <br />Health and Human Services and by established under the North Carolina Medicaid program. <br />in full, the approved reimbursement rates for <br />7. To accept, as oa ent <br />covered services. <br />g, Not to charge a recipient or any other person, would berentitled ito related or covered items and services for which the recipient <br />have payment under Medicaid. <br />or other disposition of funds <br />9. To make provision for the return <br />incorrectly collected. <br />10. To provide a statement of the amount the patient pays, incurs or is <br />obligated to pay so that it may be applied to a patient's deductible. who <br />eli 11. for rMedicaid lservicesne and th neCbillntMe icaid rforo thevr imbursable <br />service. <br />collect from a recipient amounts in excess of authorized cost <br />. Not to <br />12 <br />sharing. <br />13. That the provider may charge the patient or other persons for items and <br />services not covered, under the North Carolina Medicaid program. <br />14. To make aeffort, consistent with <br />to collect tions, <br />third party payorsaforacovered rservicesa <br />15. To maintain clinical records for deacSuch documentation wi, documenting <br />provide. d include at <br />diagnosis and the services <br />a resenting symptom(s); assessment; diagnosis <br />minimum. date of service; p rofessional providing the <br />asp appropriate. Records must <br />and description of r sigiature of <br />approved service; physician's ears from the date of er ice is <br />be retained for a minimum of five (5) y <br />five (5) years following the recipients age of majority, whichever longer. <br />