BASIC (09-06)

DI 39545.225 Purchasing Medical Services Across State Lines

A. Policy

DDSs may use a qualified medical source in a neighboring State for a consultative examination (CE), if necessary.

B. Procedure

  • Purchasing DDS will notify the non-purchasing DDS in the manner agreed upon between the DDSs.

  • DDSs should work together to reach mutually acceptable arrangements. For example, the DDS should check with its non-purchasing DDS for any medical relations problem with the out-of-State CE source.

  • If the agreement between the DDSs includes interstate purchases, the purchasing DDS must check with the DDS in the other State to verify proper licensing or certification and the absence of any program integrity or professional relations problems.

  • If the provider is not a current member of the non-purchasing State’s DDS CE panel, the purchasing DDS must check the System for Award Management (SAM) before requesting the CE. (To report fraud see, The Office of Inspector General website (http://oig.hhs.gov).

  • Purchasing DDS should use the fee schedule of the State in which the CE provider practices.

  • If the non-purchasing DDS has a higher rate of payment, the purchasing DDS should pay the higher fee if such payment is not prohibited by State law or regulation. This will help to preserve a good working relationship between the medical source and the DDS.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0439545225
DI 39545.225 - Purchasing Medical Services Across State Lines - 01/27/2016
Batch run: 01/27/2016
Rev:01/27/2016