Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

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Part 1 Medicaid Eligibility Verification 1

Transcript of Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

Page 1: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

Part 1

Medicaid Eligibility Verification

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Page 2: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

Provider One Coverage:

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Page 3: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

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Checking Coverage on ProviderOne - Step 1

Page 4: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

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Checking Coverage on ProviderOne – Step 2

Page 5: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

Checking Coverage on ProviderOne – Step 3

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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).

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Checking Coverage on ProviderOne – Step 4

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Community Health Plan of Washington Claims (CHPW)PO Box 269002Plano, TX 75026-9002Customer Service: 1-800-440-1561

Molina Healthcare of Washington, (MHC)PO Box 22612Long Beach, CA 90801Customer Service: 1-800-869-7165

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:

Page 7: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

Future State Eligibility Checking

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• -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

Page 8: Part 1 Medicaid Eligibility Verification 1. Provider One Coverage: 2.

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!!

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