| Element Monitored |
General Rule |
Nursing Rule |
Daily Living Service Rule |
| Not authorized on the consumer All Services Plan |
|
5101:3-12-06 (A)(9)(e) |
5101:3-12-06 (B)(6)(b) |
| Date of service not authorized |
|
5101:3-12-06 (A)(9) |
5101:3-12-06 (B)(6) |
| No modifier for group services |
|
5101:3-12-06 (A)(3) |
5101:3-12-06 (B)(3) |
| Duplicate billing |
5101:3-1-29 (D) |
|
|
| Not allowable family member providing services |
5101:3-12-12 (A)(2) |
5101:3-12-06 (A)(9)(a)(ii) |
5101:3-12-06 (B)(6)(a) |
| Not authorized to provide services |
(Therapy)5101:3-12-06 (C)(6) |
5101:3-12-06 (A)(9) |
5101:3-12-06 (B)(6) |
| Expired / falsified / forged license |
(Therapy)5101:3-12-06 (C) |
5101:-3-12-06 (A)(9) or 5101:3-12-06 (A)(11) |
|
| RN performing DLS only and billing as RN service |
|
5101:3-1-29 (D) |
|
| Documentation does not support claims submitted |
|
5101:3-12-06 (A)(9) |
5101:3-12-06 (B)(6) |
| Unbundling: billing for unauthorized multiple first hours |
5101:3-1-29 (D) |
5101:3-12-06 (A)(9) |
5101:3-12-06 (B)(6) |