Library: Policy

317:30-3-3. Group billings

Revised 6-25-11

(a) A group/corporation is a business entity under which one or more individual providers practice.  A group does not require multiple professional providers.  A single provider group is a valid group and would be identified by the business entity name.  Providers who are in group affiliations and providers who are incorporated under a Federal Employer Identification Number (FEIN) may be paid as a group or corporation.  Unless otherwise notified, payments will be issued to a provider as an independent provider, under the personal Social Security Number.  To be paid as a group/corporation, or under the Federal Employer Identification Number, providers must contact OHCA to secure a contract for group/corporation billing.  It will be the responsibility of the group/corporation to notify the OHCA of changes when a provider leaves or enters the group/corporation affiliation.

(b) A clinic is a facility or distinct part of a facility used for the diagnosis and treatment of outpatients.  Clinics are limited to organizations serving specialized treatment requirements or distinct groups.  Clinics are specific to specialized provider types as approved by the OHCA.  Clinics must have a specialized current contract with the OHCA.  Clinic services are covered under 317:30-5-575 through 317:30-5-578.