Fixed Fee For Service In Pennsylvania
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FAQ
The Office of Medical Assistance Programs (OMAP) administers the joint state/federal Medical Assistance (also known as Medicaid) program that provides healthcare coverage for more than 3.1 million Pennsylvania residents.
The Medically Needy Only (MNO) program lets you get Medicaid benefits even if your income is higher than Medicaid program guidelines. It works by letting you spend down your income so that you meet Medicaid income limits. The spend-down amount is the amount of income that is over the Medicaid limit.
What is a PA Waiver Program? A waiver program allows states to waive certain Medicaid requirements to provide care and support services to individuals who might otherwise require institutional care.
Generally, services are not subject to sales tax in Pennsylvania with the exception of services that are specifically identified as taxable.
Here are some helpful tips on using Medical Assistance: If you need a new ACCESS card, call: 1-877-395-8930. If you live in Philadelphia, call: 1-215-560-7226. For more information about what is included in these healthcare services along with any limits, please call: 1-800-537-8862, option # 1, # 2, # 3.
To bill Medicaid your doctor must register with DPW as a Medicaid provider, even if your doctor does not treat Medicaid patients on a regular basis.
This is a form of a contract for services. So, the bill is not untimely as the statute of limitations for contract is 4 years. However, if it was covered by insurance, then the doctor may have a problem collecting if the doctor did not submit it in time to the insurance company.
Can my provider ever bill me? Generally, the only time a provider can bill a Medicaid recipient for a service is if the service is not covered by Medicaid, the provider informed the consumer of this ahead of time, and the consumer consented to paying for the non‐covered service out‐of‐pocket.
