WAG 15-08-06.

A medical bill can be from a provider, or from a collection agent seeking payment for services or supplies from a medical provider. In order to allow a bill from a collection agent, it must be established that the bill is the client's responsibility, the same as any other bill.

When a client submits a bill, determine if the bill is a "current bill" or an "old bill." A "current bill" is a bill with a billing date (month and year) that is within 6 months of the month that the client wants to use the bill. An "old bill" is a bill with a billing date that is more than 6 calendar months from the month that the client wants to use the bill. The 6-month timeframe is the difference between the month of billing and the month the client wants to use the bill.

The reason for defining a bill as either a "current bill" or an "old bill", is to determine if the client is still responsible for payment of the bill. When a bill is an old bill (has a billing date that is more than 6 calendar months before the month that it is to be used), it must be reverified as still being the client's responsibility. Request a current statement of charges from the client.

When a bill is a current bill (has a billing date that is 6 months or less from the month that it is to be used), it does not have to be verified as a current liability, unless:

  • information provided by the client is questionable, or
  • the service date is in a period of medical eligibility and the Family Community Resource Center determines that the service is covered by Medicaid.

Questionable information would be a situation such as a bill or receipt that appears to be altered.

When it has been determined that a medical bill is the client's current liability it can be used for the month of service or carried over to a later month.