WAG 06-10-13: Provider Notice

  1. (CO) Notifies providers of the MPE client's case number and RIN for billing.
  2. (CO) Generates notice, Healthy Start - Medicaid Presumptive Eligibility (MPE) Medical Cards Issued (MM/DD/YY), daily. The notice lists all pregnant women referred by the provider who have been issued a MediPlan Card as a result of TA 10 with TAR 45, TAR 47, or TAR 49. The notice lists the following:
    • applicant's name,
    • case number,
    • RIN,
    • date of birth, and
    • MPE eligibility period.
  3. (FCRC/All Kids Unit) Notify the provider that a MediPlan card has been issued when  the MPE application is processed in IPACS.
  4. (FCRC/All Kids Unit) Complete the "HFS Use Only" section of the MPE application form.
  5. (FCRC/All Kids Unit) Send a copy to the provider.
  6. 6(FCRC/All Kids Unit) Notify the provider about the outcome of an MPE client's application for ongoing benefits.
  7. (System) Sends Notice of Decision on Application for Cash and/or Medical - Third Party (Form 360L), except when the denial is TAR 92 or TAR 93.
  8. (FCRC/All Kids Unit) Do not notify the client about actions taken on an MPE
  9. (FCRC/All Kids Unit) Send the client a Form 360 or Form 458 to notify her about the results of an application for ongoing benefits.