If a CRS participant has comparable benefits, the provider must bill the comparable benefit before billing the CRS program.

If comparable services and benefits are available, the CRS program may participate in the cost of services if the combined amount of the CRS payment and the comparable benefit payment does not exceed the maximum amount allowed by the following, as appropriate:

  • Maximum Affordable Payment Schedule (MAPS) rate;
  • contracted payment rate; or
  • retail or negotiated lower price (for non-MAPS, noncontract items).

If the comparable benefit is paid by:

  • major medical insurance, a health maintenance organization, or preferred provider organization, the CRS program may pay the participant's portion (co-payment, coinsurance, and any unmet deductible), not to exceed the MAPS rate, contract rate, or retail price, as applicable.
  • Medicare, the CRS program may pay the participant's portion (co-payment, coinsurance, and any unmet deductible), not to exceed the MAPS rate, contract rate, or retail price, as applicable.
  • Medicaid, the CRS program pays nothing. The CRS program does not supplement a Medicaid payment for a specific service or procedure.
  • Out of Network, the CRS program may pay up to but not exceeding the contracted rate.