If a provider has performed a sterilization and the client gets retroactive eligibility, can the provider bill Medicaid without the sterilization form?
A. No. You cannot bill Medicaid without the correct form. If the provider suspects that the client may become eligible for Medicaid, the provider should have the client sign the form prior to the sterilization. However, for a medically necessary sterilization, you can send the claim and supporting documentation, including operative notes and the physician’s statement to the Department for review. Q. A client became retroactively eligible during his hospital stay. He was in the hospital on 05/30/01, but he was eligible for Medicaid on 06/01/01. Medicare requires dates of service from 05/30/01. How can the provider bill this? A. The provider will have to prorate the stay for Medicaid eligibility both on the Medicare EOB and on the Medicaid claim.
