Ala. Admin. Code r. 560-X-1-.11

Current through Register Vol. 43, No. 02, November 27, 2024

Section 560-X-1-.11 - Medicaid Eligibility Card

Individuals certified eligible for Medicaid will receive a plastic Medicaid Card through the mail with the following exceptions: certain unborns; recipients certified with a pseudo number; Medicare Savings Programs other than "QMB; and recipients certified for a closed period of retroactive eligibility. These individuals will receive a paper Medicaid card. Also, Medicaid recipients residing in a long term care facility will not receive a plastic Medicaid card. Each month the long term care provider will receive a computer printout listing of all Medicaid eligible recipients in the respective facility.

(1) The recipient is required to present his plastic Medicaid card and proper identification to a provider of medical care or services. The provider must verify eligibility through web portal, AVRS, MACSAS, or the Provider Inquiry Unit.

(2) Medicaid claims may be submitted for incurred charges during three months prior to the month of application. Eligibility must be established before claims submission may be paid.

(3) When a recipient loses or fails to receive a plastic eligibility card he/she should write or call the Alabama Medicaid Agency.

(a) Should the recipient require Medicaid services before receiving a replacement card he/she is responsible for furnishing his/her Medicaid number to the provider at a later time.

(b) Providers of Medicaid services shall obtain the Medicaid eligibility number directly from the recipient to verify eligibility or submit claims for services furnished the recipient. Where the Medicaid number is not available from the recipient, it may be obtained from the Medicaid Agency by sending a completed inquiry form. Providers must state in their request that they have provided authorized services, supplies, or equipment to the individual whose Medicaid number is being verified.

(c) Claims submitted for services furnished a recipient must contain all 13 digits of the recipient's Medicaid number.

(4) Providers of Medicaid services shall not submit lists of names, addresses and/or Medicaid numbers of individuals to the Alabama Medicaid Agency for verification of eligibility.

Ala. Admin. Code r. 560-X-1-.11

Rule effective October 1, 1982. Amended; effective May 1, 1983; January 8, 1985. Emergency Rule: Effective April 5, 1985. Amended: Effective July 9, 1985; August 10, 1987; November 10, 1987. Emergency Rule effective November 16, 1987. Amended: Effective March 12, 1988; January 13, 1993. Amended: Filed September 11, 2013; effective October 16, 2013.

Author: Kathy Hall, Deputy Commissioner, Program Administration

Statutory Authority: State Plan; Social Security Act, Title XIX; 42 C.F.R. §§430, et seq.; Provider Notice 82-28, September 27, 1982.