PM 04-01-07-b.

When a woman does not have a medical provider to verify her pregnancy, take the following actions:

  1. Complete Verification of Pregnancy (Form 2304).
  2. Contact an approved Medicaid provider, and arrange for the woman to have a pregnancy test. The pregnancy may be verified by a doctor, clinic, social service agency such as Planned Parenthood or other qualified medical personnel.
  3. Explain to the provider that Medicaid will only pay for the office visit and the laboratory test to determine pregnancy. No other services can be authorized.
  4. Send Form 2304 to the medical provider along with a pre-addressed return envelope.
  5. Prepare an Invoice Voucher (Form C-13) when the provider returns Form 2304 along with a bill. The C-13 must contain the client's name, case address, and the statement "Administrative Expense for Pregnancy Test". See WAG 26-04-01 for instructions on completing a C-13.
  6. Send the completed C-13 and the provider's bill to the Bureau of Fiscal Operations.
  7. File Form 2304 in the case record as proof of the pregnancy.