1. (1) Providers should not send recipients bills or statements for covered services once that recipient has been accepted as a Medicaid patient.
2. (2) Providers may send a notice to the recipient stating their claim is still outstanding if the notice indicates in bold letters: "THIS IS NOT A BILL."
3. (3) Providers are responsible for follow-up with the fiscal agent or Medicaid on any billing problems or unpaid claims.
4. (4) The Recipients are not responsible for the difference between charges billed and the amount paid by Medicaid for covered charges services.
5. (5) Providers agree to accept the amount paid by Medicaid as payment in full.
6. (6) Recipients may be billed only for the allowable copayment amount, for services not covered by Medicaid, or when benefits have been exhausted.
7. (7) Providers may not deny services to any eligible recipient due to the recipient’s inability to pay the allowable copayment amount.

Author: Lynn Sharp, Associate Director, Policy Development Unit

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§447.15, 447.50, 447.55.

History: Rule effective October 1, 1982. Amended effective July 9, 1984; June 8, 1985. Amended: Filed March 7, 1997; effective April 11, 1997. Amended: Filed August 6, 1999; effective September 10, 1999.