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days from the date on IQMA indicating card generation. This allows the appropriate length of time to produce and mail the card. If, within the full seven days, the client still has not received the card, the worker must check the recipient’s address on AEICI or AEIII as appropriate, and make sure it is entered correctly before requesting a replacement.

3618.00.00 RESERVED

3618.05.00 NON-CLAIMS SUBMITTED TO DFR (MED 1)

As of June 1, 2014, this section no longer applies.

3618.10.00 DISALLOWED NON-CLAIMS (MED 1)

As of June 1, 2014, this section no longer applies.

3618.15.00 MEDICAID HCBS LIABILITY SUMMARY NOTICE (MED 1)

On the second business day of every month the Core MMIS system generates the monthly Medicaid HCBS Liability Summary Notice. A notice will be issued to every liability recipient for whom claims were applied to the liability during the month. A copy of the notice will be sent to the member and any authorized representatives. In the case of a recipient couple, each member of the couple will receive a notice. More than one month of claims activity may be listed on the notice. The notice reports claims processed during the month without regard to the date(s) of the service.

The Medicaid HCBS Liability Summary Notice is a very important document for liability recipients. The notice informs them of how and to what services their waiver liability was applied. The notice informs them of the amount of their waiver liability that they owe to each medical provider. Except for pharmacies, medical providers may not collect payment from their waiver liability patients, until the patient is notified via the Medicaid HCBS Liability Summary Notice of the amount of the bill that was applied to the patient’s waiver liability. Because of the point of service billing device used by pharmacies to submit Medicaid claims, they know the amount of the waiver liability that was credited to their claim when the prescription is dispensed.

DFR staff should stress to recipients and their authorized representatives the importance of retaining these notices. The notices are important for the client’s personal record keeping. If recipients have questions about a certain amount that is shown as being owed to a certain provider, they should contact the provider first. Providers are notified via a weekly Remittance Advice (RA) statement of how much of a waiver liability was applied to their claim. The provider’s notification and the recipients should match.

If questions cannot be resolved with the provider, the recipient should contact Member Services. DFR does not receive copies of the Medicaid HCBS Liability Summary Notice and do not have information available to them that would allow them to answer questions or resolve any