WAG 20-03-00.

The central office and the Family Community Resource Centers are responsible for administering the medical program.

The central office:

  • checks medical services to see that the services given meet the clients' needs;
  • reviews medical services to uncover provider fraud and abuse. If fraud or abuse is discovered, HFS may suspend or remove a provider from the medical program;
  • gives providers the forms needed to submit bills and helps them complete the forms if needed;
  • pays correctly completed and submitted bills from providers as timely as possible;
  • when asked by a client, reviews a bill when the client is being threatened about payment and the client believes the bill should have been paid by HFS; and
  • provides evidence of prior health coverage, as required by the Health Insurance Portability and Accountability Act (HIPAA), to help a person enroll in a private or group health care plan.

The Family Community Resource Center gives information about the medical program to anyone who makes a specific request. The information requested must be reasonable.