NewsTMHP issues Medicaid Notice of Incorrect PaymentsAug 7, 2009It looks like claims were paid in error for clients enrolled in the Women's Health Program (WHP). These clients are not eligible for most Medicaid services including ambulance services. Unfortunately, ambulance claims were paid and it looks like those claims will be reprocessed for Medicaid to recoup the payment. There are about 800 claims going back to September 2007. The clients who received these services are responsible for payment. A provider notice is being prepared and should be issued in the next few weeks. The lesson here is for providers to be very careful to verify if a client is Medicaid eligible, determine which Medicaid program the client is enrolled in, and identify any service limitations related to that program. The Medicaid - Women's Health Program has a very limited set of services that do not include ambulance services. There are about 83,000 women statewide enrolled in the WHP at any time. The following are benefits to clients who are enrolled under WHP: * Comprehensive health history * Gynecological examination and Pap smear * Screening for diabetes, sexually transmitted diseases, high blood pressure, and breast and cervical cancers * Assessment of health risk factors, such as smoking, obesity, and exercise * Counseling and education on birth control methods, including the benefits of abstinence * Birth control (except emergency contraception) |
