New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 600 - FINANCIAL ASSISTANCE AND ELIGIBILITY FOR MEDICAL CARE
Part He-W 606 - VERIFICATION
Section He-W 606.89 - In and Out Medically Needy Medical Assistance
Universal Citation: NH Admin Rules He-W 606.89
Current through Register No. 40, October 3, 2024
(a) When requested to do so by the district office in accordance with He-W 678.01, the client shall provide documentation of the following:
(1) Incurred current medical
expenses and obligated prior medical debts, including those of individuals and
family members living in the same household as described in He-W 601.72 and
He-W 601.74, or for whom the client is liable;
(2) Medical services and amounts that are
subject to third party reimbursement or insurance coverage; and
(3) The relationship between the client and
the individual for whom medical expenses are claimed.
(b) Acceptable documentation of the above criteria shall include, but not be limited to:
(1) Provider bills, reminder notices and
collection agency notices which are dated within 30 days of the month to which
the debt is expected to be applied;
(2) A statement from the insurance company of
the intent to pay covered charges, or the medical service provider's bill
showing insurance payment;
(3)
District office collateral verification by letter or telephone with the
insurance or medical provider of the charges and allowances toward medical
services;
(4) Historical data
previously received by the district office which documents the amount of the
charges and allowances toward recurring medical services; and
(5) A birth certificate, baptismal record,
marriage certificate, or other document that establishes the relationship
between the client and the individual for whom medical expenses are
claimed.
(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5508, eff 12-1-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06
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