501           MEDICAID RECIPIENT IDENTIFICATION CARD

 

501 A.      ISSUING MEDICAID TO ELIGIBLE RECIPIENTS

 

There are four ways that the Department issues written documentation that a recipient is eligible for APA-related Medicaid coverage in a given month.  These documents inform the recipient and their health care provider of the recipient’s Medicaid identification number (e.g., 060000000 / 060100000), which is needed by the provider when submitting a claim for payment to Medicaid.  Many medical providers require written proof of Medicaid eligibility before they will provide service to an individual.  Any of the following documents will serve as proof of Medicaid eligibility:

 

1. Standard System Issued Recipient Identification Card

 

  1.     Each person approved for Medicaid will receive Medicaid Recipient Identification (ID) card.  Children enrolled in Medicaid will receive a Denali KidCare card while adults will receive a Denali Care card.  This includes Medicaid cases authorized in both EIS and ARIES.  This card can be used for health care and certain medical related services only for the person named on the card. The coverage period is generally twelve months and is valid for the period shown on the front of the card as long as the recipient remains eligible.  Although the cards display Coverage Effective Dates, it is not a guarantee of coverage or eligibility.

 

  1.    Standard cards are mailed to recipients for the following circumstances:

• One card per recipient per authorized review

• One card per new member add-on

 

          Cards can also be reissued for the following circumstances:

• Change in name

• client identification number

• date of birth

• eligibility code

• coverage effective dates or resource code

• Lost, stolen or client request

 

  1. Cards are not issued to recipients eligible for retroactive Medicaid or a Medicare Part A and B buy-in categories.

 

2. Non-Standard System Issued Recipient Identification Card

 

A non-standard Recipient Identification card has similar recipient and medical resource information as the standard Denali Care or Denali KidCare card, but is used for a recipient whose Medicaid coverage is restricted to certain services, such as an exam for a blindness or disability determination, waiver screening or Chronic and Acute Medical Assistance (CAMA).  This ID card contains a statement of the service limitation.  A provider may photocopy this card and submit it with their claim for reimbursement.
 

3. Field Benefit Issuance

 

Once Medicaid coverage has been authorized in ARIES or EIS a Field Benefit Issuance can be printed at any DPA office.  A Field Benefit Issuance contains similar recipient and medical resource information as a standard system issued Denali Care or Denali KidCare ID card.  A Field Benefit Issuance is provided when the Denali Care or Denali KidCare Card is needed immediately and the recipient cannot wait for mail delivery.  A Field Benefit Issuance printed from ARIES looks different than a Field Benefit Issuance printed from EIS.

 

Note:  

Do not F9 out of the MEMC screen on EIS unless you want to cancel the issuance.  You must always type in the "F" issuance indicator and press "Enter" to record the issuance so the recipient’s medical claims will be paid.  

 

4. Manual Benefit Issuance

 

  1.    A Manual Benefit Issuance is the only form of documentation that can be printed for aliens eligible for emergency treatment because coverage for this special category is not considered regular Medicaid.  Although similar to a Field Benefit Issuance, additional instructions must be entered in the Special Information field on the Manual Benefit Issuance to specify the covered dates of services. A Manual Benefit Issuance printed from ARIES looks different than a Manual Benefit Issuance printed from EIS.

 

  1.    A Manual Card for a recipient eligible for any category of Medicaid or CAMA that is assigned for the

                  Care Management Program can only be printed by Xerox State Healthcare, LLC.  A card can be

                  requested on behalf of the recipient by contacting the Xerox Care Management Coordination Line at

                  907-644-6842.

 

501 B.      AUTHORIZED REPRESENTATIVE

 

If an authorized representative (e.g., a public guardian) requests the Recipient Identification card and notices to be sent to him or her, the caseworker must enter the authorized representative's address in the mailing address field on the EIS Address (ADDR) screen.  To have the Medicaid ID cards mailed to the recipient and the notices mailed to the representative, the authorized representative's address must be entered in the mailing address field on the ADDR and the recipient's address in the Medicaid benefit address field on the ADD2 screen.

 

501 C.      USING THE ID CARD OR MANUAL COUPON

 

The caseworker must advise the recipient that it is the recipient’s responsibility to:

 

  1. Present a current ID card or manual coupon when each medical service is received;
     

  2. Ensure that the medical provider they choose is an enrolled provider in the Alaska Medicaid program;
     

  3. Ensure that the service they are receiving is covered by Medicaid;
     

  4. Be prepared to present proof of their identity;
     

  5. Guard their coupons to prevent use by unauthorized persons; and
     

  6. Pay for any medical services for which an ID card or manual coupon was not properly presented.

 

 

 

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MC #31 (09/13)