Verification of Eligibility

Verification of Eligibility A. It is the responsibility of the Medicaid provider to verify a Medicaid beneficiary’s eligibility each time the beneficiary appears for a service. Evidence of eligibility is demonstrated by the Medicaid identification card issued to each Medicaid eligible member in a family. A beneficiary is expected to present his/her Medicaid identification card when services are rendered. B. A picture ID such as a driver’s license or school ID card is required to confirm the identity of the person presenting for service. If no picture ID is available, verification must be made by verifying the social security number and/or date of birth. C. If it is found that the person presenting for services was not the Medicaid beneficiary to whom the card was issued, the provider is responsible for refunding any monies paid by Medicaid to the provider for those services provided. D. A plastic identification card is not a guarantee of Medicaid eligibility. E. Medicaid providers may verify beneficiary eligibility status by one (1) of the following methods: 1. Calling the Automated Voice Response System (AVRS), 2. Using the point of service eligibility verification system, or 3. Calling the fiscal agent.