*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: January 1, 2010 |
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24.15.05 - Verification of Health Care Expenses |
Archived: June 1, 2016 (Previous Version) |
Health Care Expenses Verification Requirements.
Health Care Expenses Verification Requirements
Verify all health care expenses used to determine if a client can meet a spenddown.
Verify health care expenses through one of the following:
l Copies of bills the client received from the provider.
Note: If bills provided by the client are not from the current billing cycle, request the current bill from the client or obtain permission from the client to contact the provider to verify that the amount of the bill is still accurate.
l Copies of the Explanation of Benefits (EOB) from third party payors.
l Contact with the provider.
For each health care expense verify:
l The date of service.
l Who the medical service was for.
l The full cost of the service and the amount remaining to be paid.
Note: Do not include finance charges or late fees in the total cost of the service.
l The exact amounts paid by the client or third parties.
l Any insurance or other third party payments.
l Any insurance or other third party denials.
For health care expenses that are older than a year, verify whether the health care provider has written off any portion of the bill and no longer expects the client to pay it.
Unverified health care expenses cannot be used to meet a spenddown.
Exceptions: MinnesotaCare inpatient hospital expenses for which the client cannot provide verification of costs may be used to meet a spenddown. Verify these expenses by requesting a claims report form MMIS. It is not necessary to verify remedial care expenses.
l Do not delay acting on the MA application if you cannot verify inpatient hospital expenses.
l For details on how to calculate the spenddown using the following types of health care expense see:
n MinnesotaCare Expenses Used to Meet Spenddown.
n P bills.
n Applications.