What happens when our member seeks services from a provider that has not been authorized by us to render care to that member?
A. You approve services for your members. You are not obligated to pay a provider for care you have not approved (unless it is an emergency). This is true even if the provider collected a copayment from your member. The provider should check the Medicaid Identification of your member before serving the patient. This includes confirming the patient’s benefit package and managed care plan coverage using Automated Voice Response or the Provider Web Portal.
