Part 1 Medicaid Eligibility Verification

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Presentation transcript:

Part 1 Medicaid Eligibility Verification

Provider One Coverage: 2 2

Checking Coverage on ProviderOne - Step 1

Checking Coverage on ProviderOne – Step 2

Checking Coverage on ProviderOne – Step 3 A. The type of coverage for the client. B. Recipient Aid Category. C. Name of Benefit Service Package (BSP). D. Start date for this eligibility segment. E. End date for this eligibility segment. F. Medical coverage group codes assigned by the Community Service Office (CSO) or the Home and Community Service (HCS) Office when eligibility is determined. G. Case number assigned by CSO or HCS. H. Retroactive eligibility information. This reflects the three calendar months before the month the client applied for services. (WAC 182-502-0150). I. Delayed certification date. Sometimes a person applies for a medical program prior to the month of service and a delay occurs in the processing of the application. In these cases, the eligibility determination date is after the actual month of service and a date will be displayed in this location. Medical Assistance can accept claims up to one year past this date (WAC 182-502-0150). 5 5

Checking Coverage on ProviderOne – Step 4 Scroll Down to the Bottom!!!! If a patient has a healthy options plan, the bottom of the ProviderOne search will tell you. Do not add Medicaid payers to Managed Care covered patients Add these payers instead: Community Health Plan of Washington Claims (CHPW) PO Box 269002 Plano, TX 75026-9002 Customer Service: 1-800-440-1561 Molina Healthcare of Washington, (MHC) PO Box 22612 Long Beach, CA 90801 Customer Service: 1-800-869-7165 6 6

Future State Eligibility Checking -Call center performs eligibility checks 1 day prior to check in. -Front desk checks eligibility for add-on appointments and beginning of the month visits -Billing checks eligibility only if claim denies or special billing circumstances

Questions? The billing department is ready and willing to take your calls regarding any insurance questions. Call Extension 7916 You can ask your supervisor or lead Jessica Johnston (# 2568) and Jennifer Nelson (# 2548)are also available to help you succeed!!