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MEDICAID INFORMATION RELEASE MA05-08
posted on March 02, 2009 12:18
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:
Client and provider complete program questions and determine if client is eligible for the PE program.
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.
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:
Verify client’s eligibility using MAVIS or electronic software. See your provider manual, Section 1., General Provider and Client Information, for instructions on verifying eligibility. This section may be accessed online at:
http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s1_gen_info.pdf
Submit your claim with client’s Medicaid ID number, (
not 9999999
).
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”.
LC/af
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