Acts and Regulations

84-115 - General

Section 13
Disposition versions

Full text
13(1)In this section, “assessment”, with respect to accounts submitted for payment under the health services plan, means
(a) the evaluation of such accounts,
(b) the investigation of such accounts to determine their correctness or validity, and
(c) the application and interpretation of the payment Schedules, by the Director to permit a determination as to whether payment should be made under the health services plan with respect to the accounts so submitted,
and “to assess” has a corresponding meaning.
13(2)The Director may, in his sole discretion, require any person who has submitted an account for payment under the health services plan to supply such additional information within such time as in the opinion of the Director is necessary to enable an assessment to be made under this section.
13(3)The Director may
(a) develop rules applicable to assessment under this section,
(b) assess accounts submitted for payment under the health services plan, and
(c) take such action with respect to the payment of accounts so assessed, including the making of orders
(i) denying payment of an account, or
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the payment Schedule for the entitled service,
which, in the Director’s opinion, will give effect to assessments made under this section.
13(4)No payment shall be made or authorized under the health services plan with respect to services which, in the opinion of the Director, are not entitled services under this Regulation.
13(1)In this section, “assessment”, with respect to accounts submitted for payment under the health services plan, means
(a) the evaluation of such accounts,
(b) the investigation of such accounts to determine their correctness or validity, and
(c) the application and interpretation of the payment Schedules, by the Director to permit a determination as to whether payment should be made under the health services plan with respect to the accounts so submitted,
and “to assess” has a corresponding meaning.
13(2)The Director may, in his sole discretion, require any person who has submitted an account for payment under the health services plan to supply such additional information within such time as in the opinion of the Director is necessary to enable an assessment to be made under this section.
13(3)The Director may
(a) develop rules applicable to assessment under this section,
(b) assess accounts submitted for payment under the health services plan, and
(c) take such action with respect to the payment of accounts so assessed, including the making of orders
(i) denying payment of an account, or
(ii) providing that payment with respect to any entitled service for which payment is claimed in an account be made at a rate less than that provided in the payment Schedule for the entitled service,
which, in the Director’s opinion, will give effect to assessments made under this section.
13(4)No payment shall be made or authorized under the health services plan with respect to services which, in the opinion of the Director, are not entitled services under this Regulation.