Claims for non-emergency items or services furnished by a debarred or suspended provider.

CFR · 2024-01-01 · US · Title 5

(a) (b) (1) That the provider is debarred or suspended and is prohibited from receiving payment of FEHBP funds for items or services furnished after the effective date of the debarment or suspension; (2) That claims may not be paid for items or services furnished by the debarred or suspended provider after the covered individual is informed of the debarment or suspension; (3) That the current claim is being paid as a legally-authorized exception to the effect of the debarment or suspension in order to protect covered individuals who obtain items or services without knowledge of their provider's debarment or suspension; (4) That FEHBP carriers are required to deny payment of any claim for items or services rendered by a debarred or suspended provider 15 days or longer after the date of the notice described in paragraph (b) of this section, unless the covered individual had no knowledge of the provider's debarment or suspension when the items or services were rendered; (5) The minimum period remaining in the provider's debarment or suspension; and (6) That FEHBP funds cannot otherwise be paid to the provider until OPM terminates the debarment or suspension.

official document · source cfr-2024 · id 5:§ 890.1049