Providers who furnish services to medicaid recipients agree
to comply with all federal and state laws and regulations relevant to the
provision of medical services, including but not limited to, Title XIX of the
Social Security Act, the Medicare and Medicaid Anti Fraud Act, and the state
Medicaid Fraud Act. Providers also agree to conform to the MAD policies and
instructions as specified in this manual and its appendices, as updated.
A. Recipient eligibility verification:
Providers must verify that services they furnish are provided to eligible
recipients. Providers must verify that recipients are eligible and remain
eligible for medicaid through periods of continued and extended services. By
verifying eligibility, a provider is informed of restrictions that may apply to
recipient's eligibility. Providers may verify eligibility through several
mechanisms, including using an automated voice response system, contacting the
medicaid fiscal agent contractor eligibility help desk, contracting with a
medicaid eligibility verification system (MEVS) vendor, or contracting with a
medicaid magnetic swipe card vendor.
B. Requirements for updating information:
Providers must furnish in writing to MAD or the MAD claims processing
contractor with complete information changes in their address, license,
certification, board specialties, corporate name or corporate ownership, and a
statement as to the continuing liability of the provider for any recoverable
obligation to MAD which occurred or may have occurred prior to any sale,
merger, consolidation, dissolution or other disposition of the health care
provider group or individual.
C.
Documentation requirements: Providers must maintain records to fully disclose
the nature, quality, amount, and medical necessity of services furnished to
recipients who are currently receiving or who have received medical services in
the past.
