Provider Billing Elements
| 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) |