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April 1, 2005   
 
MEDICAID INFORMATION RELEASE MA05-08
 
TO:                 PWC (Pregnant Women and Children) Clinic Providers
 
FROM:           Leslie Clement, Acting Deputy Administrator
 
SUBJECT:     CHANGE IN BILLING PROCEDURES FOR PRESUMPTIVE ELIGIBILITY (PE) CLIENTS WHO ARE PREGNANT
 
Medicaid is changing the process for submitting claims for Presumptive Eligibility (PE) clients in order to decrease claim processing time and assure claim payment accuracy.
 
Eligibility for pregnancy services under the PE program is determined as follows:
  1. Client and provider complete program questions and determine if client is eligible for the PE program.
  2. Client’s local field office receives the application for services from the provider, processes it, and issues a Medicaid number for client’s PE eligibility period.
  3. Client’s Presumptive Eligibility period ends after a maximum coverage period of 45 days or sooner if the candidate is eligible for PWC (Pregnant Women and Children) or another Medicaid program.
 
Claims received by EDS on or after 4/1/2005 with a 9999999 in the client ID number field will be automatically denied. Please follow these steps to submit your claims:
 
If you have any questions regarding these billing requirements, please contact EDS at 383-4310 (in Boise) or 1-800-685-3757.  Thank you for your continued participation in the Idaho Medicaid Program.
 
IDAHO MEDICAID PROVIDER HANDBOOK:
This Information Release replaces information found in Section 1., 1.4.1.1 – Program Procedures for pregnant women (PWC) PE which states “Providers who serve PE clients mark these claims with “9999999” in the insured’s ID number field”.
 
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