Current through September 24, 2024
A. Medicaid
providers must:
1. Identify and report any
third party source to the Division of Medicaid.
2. Cooperate with the Division of Medicaid in
the recovery of payments from the third party source. Providers will be held
liable, to the extent of the Division of Medicaid's payment, for failure to
cooperate with the Division of Medicaid's staff when they have knowledge of
third party coverage.
3. Accept
either the third party payment or the Division of Medicaid's payment for
services provided as payment in full.
B. Providers cannot refuse to furnish
Medicaid covered services to a beneficiary because of a third party's potential
liability for the services.
C. The
Division of Medicaid may reduce any payment amount otherwise due the provider
by up to three (3) times the amount incorrectly received from the beneficiary
if the provider is found in violation of Miss. Admin. Code Part 306, Rule
1.3.C.
D. The provider must obtain a signed
statement from the beneficiary if beneficiary indicates they no longer have
third party insurance. The statement must include the name of the insurance
company, the policy number, and the beginning and ending date of coverage and
must be submitted to the Division of Medicaid.
E. Requests for Medical Information
1. The Division of Medicaid requires that any
medical information concerning a Medicaid beneficiary released by a provider
must contain the following information:
a) The
person is or was a Medicaid beneficiary at the time the services were
rendered,
b) His/her Medicaid
identification number, and
c) The
claim has been submitted to the Division of Medicaid or has been paid by the
Division of Medicaid.
2.
If a provider receives a request for medical claims or other medical
information from a Medicaid beneficiary or someone acting on the beneficiary's
behalf, such as an attorney, insurance company, etc., release of said
information will be restricted as follows:
a)
Copies of claims or medical records requested by a beneficiary or the
beneficiary's parent, guardian or legal representative must be furnished if the
provider receives a written authorization for release of the
information.
b) Information
requested by an insurance carrier with whom a claim has been filed must be
furnished directly to the carrier.
c) The provider must comply promptly to a
request for medical information from a Medicaid beneficiary's attorney once a
signed authorization from the beneficiary has been received.
d) Medical records or billing information
requested by the Disability Determination Service (DDS) or a school system, for
educational evaluation, must be sent directly to the requester. Notification to
the Division of Medicaid is not necessary.
42 CFR §§
433.136,
433.137,
433.145; Miss. Code Ann.
§§
43-13-121,
43-13-125,
43-13-305,
43-13-311,
43-13-313.