970 THE CAMAChronic and Acute Medical Assistance AUTHORIZATION (COUPON)
The recipientAn individual who is receiving a public assistance program. must guard his or her medical authorization (coupon) with reasonable care to prevent its use by unauthorized individuals.
The CAMAChronic and Acute Medical Assistance coupon is proof that a recipientAn individual who is receiving a public assistance program. is eligible to receive CAMAChronic and Acute Medical Assistance services as specified on the coupon in a given month. See Appendix C for an example of a CAMAChronic and Acute Medical Assistance coupon.
When securing medical treatment, the recipientAn individual who is receiving a public assistance program. is to present the coupon and give it to the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program.. The recipientAn individual who is receiving a public assistance program. should be prepared to provide identification if required by the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program.. The coupon is good only for those services covered by the CAMAChronic and Acute Medical Assistance program and available from enrolled providers.
The coupon contains the recipient’s name, ID number, date of birth, month and year of eligibility, eligibility code, subtype, and up to three resourceSomething owned by or available to an individual that may provide a means of financial support, and which must be considered when determining eligibility. codes for each individual listed.
970-1 PURPOSE OF THE AUTHORIZATION
Each CAMAChronic and Acute Medical Assistance coupon serves the following purpose:
- verifies a recipient’s eligibility, which protects the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. against possible misrepresentation;
- informs the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. what services the recipientAn individual who is receiving a public assistance program. is eligible to receive; and
- expedites payment to the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. for services rendered.
Note:
CAMAChronic and Acute Medical Assistance does not reimburse a recipientAn individual who is receiving a public assistance program. for any payments already made to a providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program..
970-2 ELIGIBILITY CODE AND MEDICAL SUBTYPE
The CAMAChronic and Acute Medical Assistance program uses one primary medical (med) subtype and eligibility code entered in EISEligibility Information System to designate the specific services that the recipientAn individual who is receiving a public assistance program. is eligible. The med subtype drives the statement of service limitations that is printed on the coupon. Once the caseworker enters the eligibility code and med subtype on the MEREMedical Reference screen screen, the service restrictions will be printed on the coupon.
| EISEligibility Information System Guide: CAMAChronic and Acute Medical Assistance med subtypes and their corresponding service limits are: |
| GJ |
Authorization limited to physician services, prior-authorized outpatient hospital radiation and chemotherapy, 3 prescriptions per month, and limited medical supplies. |
| GP |
Care Management Program. |
| Eligibility code 21 is used with the med subtypes |
970-3 DISTRIBUTION OF CAMAChronic and Acute Medical Assistance AUTHORIZATIONS
CAMAChronic and Acute Medical Assistance authorizations (coupons) may be issued either by the EISEligibility Information System computer system or manually from a local DPADivision of Public Assistance office.
A. SYSTEM GENERATED COUPONS
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EISEligibility Information System GUIDE: CAMAChronic and Acute Medical Assistance coupons will be issued from DPA’s System Operations according to their EISEligibility Information System production schedule, usually three times a week. An issuance is requested by caseworker authorization of a benefit with either an “I” or “R” issuance indicator. Benefits authorized with an “I” indicator are issued with the next scheduled (immediate) issuance job. Those with an “R” are issued with the next monthly (regular) issuance.
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B. MANUALLY ISSUED COUPONS
Once a CAMAChronic and Acute Medical Assistance benefit has been authorized by a caseworker, a coupon can be printed on the special coupon stock located in the local DPADivision of Public Assistance office. This type of coupon is generally issued when the individual needs additional coupons for multiple providers.
EISEligibility Information System GUIDE: Issue manual coupons from EISEligibility Information System as follows:
- Advance to the GMIHCAMA Issuance History or GMBHCAMA Benefit History screen and select the month for which the coupon is requested by placing an “X” next to the month and pressing enter. NOTE: A benefit that has not been previously issued will not appear on the GMIHCAMA Issuance History.
- The MedicaidA needs based program that pays for medical care provided to individuals who are categorically and financially eligible. General eligibility categories include pregnant women; dependent children; individuals needing an institutional level of care; and aged, blind, and disabled individuals. Manual Coupon Issuance (MEMCMedical Manual Coupon Issuance) screen will be displayed for the month selected with the service limitation statement according to the med subtype on the case.
- Type “F” in the issuance indicator field and press enter. MEMCMedical Manual Coupon Issuance redisplays with the issuance indicator hard-coded and document ID field completed.
IMPORTANT: Do not F9 out of the MEMCMedical Manual Coupon Issuance screen unless you want to cancel the issuance. You must always press enter from the MEMCMedical Manual Coupon Issuance to record the issuance so the recipient’s medical claims will be paid.
- One MEMCMedical Manual Coupon Issuance screen per full 8-1/2” x 11” page may be printed as many times as necessary.
- Each coupon must be signed (no initials) before it is released to the recipientAn individual who is receiving a public assistance program..
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