Customer Contact Center Food Stamp/Family Medicaid Phase II ...

Call Center FS/FM SUCCESS PG October 24, 2007
Introduction to Training
MEDICAID GENERALLY COVERS THE FOLLOWING:
❂
inpatient hospital services with the following restrictions:
✗
✗
✗
one daily physician’s visit
one pre-operative in-patient day
no reimbursement for Friday, Saturday or day-before-holiday admissions,
except for emergencies
❂
outpatient services with the following restrictions:
✗
✗
visits must be medically justified
services are limited to hospitals with organized outpatient clinics
❂
❂
x-ray and laboratory services
prescriptions, drugs and supplies with the following restrictions:
✗
✗
✗
6 prescriptions per child per month and 5 prescriptions per adult per month
unless the physician receives pre-approval from DMA for more than the limit
drugs must be on the approved list authorized by DMA
AUs must use the same pharmacy throughout the month for all individuals
listed on the Medicaid card
❂
physician’s services with the following restrictions:
✗
✗
✗
✗
12 physician office visits per AU member per fiscal year
services necessary for the diagnosis or treatment of illness or injury
family planning services; limited to two per AU member per fiscal year
voluntary sterilization
✗ Healthcheck services for individuals under 21
✗
vaccinations only if directly related to treatment of an injury or direct exposure
❂
the charge for Supplementary Medical Insurance for those eligible for Medicaid
and Medicare
PG-22