Verify expense incurred during the current c.p. by examining receipts, bills, and statements.
Verify the unpaid balance of bills incurred prior to a current c.p. for:
REVISED 11/01/11 - CHANGE NOTICE 17-11
Complete the DMA-5037, Medical Provider Verification Form, for each identified medical provider. The a/b may assume responsibility for obtaining provider verification, but IMC must assist if the a/b requests assistance. The a/b may also meet this requirement by presenting a current bill that includes:
When there is third party insurance coverage at the time a medical charge is incurred, document the status of the insurance claim by reviewing the Explanation of Benefits or contacting the insurance company or medical provider.
If the claim has been denied, document the reason for the denial. This is necessary to determine what remaining charges, if any, may be applied to the a/b's deductible. (Refer to V.B.3., above.)
If the insurance claim is denied because the a/b or a financially responsible person did not comply with the requirements of the plan, Medicaid will not pay the remaining charges nor can the charges be applied to the a/b's deductible.
Document charges applied to the current Medicaid deductible on the DMA-5036, Record of Medical Expenses Applied to the Deductible. Include date of service, patient name, provider name, and amount for each charge. If the a/b is not responsible for the entire charge, include the amount for which he is responsible. If medical bills are for dates of service prior to the current c.p., verify the a/b's current liability.
REISSUED 11/01/11 - CHANGE NOTICE 17-11
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.