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Q. Who can clients call if they are confused about their copayment requirements? A. Clients who need help understanding their copayment requirements can call our Client Advisory Services Unit, (1-800) 273-0557. They can also call their caseworker. Q. Which of my patients are subject to copayments? Are children subject to these copayments? A. Children under age 19 do not have copayments. The OHP Standard benefit package does not have copayments. The OHP Plus and OHP with Limited Drug benefit packages do not have copayments for specific outpatient services and prescription drugs for some adults. The OMAP Medical Care Identification shows the benefit package and the copayment information for each member of the household. Some adults are exempt from copayments. Copayments are not charged to adults who are:
Q. Which providers and services are subject to copayments? A. A table listing the services for which copayments are to be charged under the OHP Plus and OHP with Limited Drug benefit packages is available here in PDF format. (The OHP Standard benefit package does not have copayments.) It also provides links to the provider rules. Only those provider types listed in the table may charge a copayment. A copayment for an outpatient service will be $3 per visit per day. For prescription drugs, it will be $2 for generic drugs and $3 for brand-name drugs. However, providers do not charge copayments for services and drugs covered by a Prepaid Health Plan for an enrolled client. Back to top Q. How do you account for OHP copayments in your provider reimbursement system? A. We compute the total OHP copayment due for services you render. (The OHP Standard benefit package does not have copayments.) We pay the total allowable amount, minus the correct copayments and any third-party payments. Our explanation of benefits (EOB) identifies copayment deductions. Please read our provider rules and draft rules. You should also review our rules for submitting claims for payment. Back to top Q. Are OHP copayments charged per procedure, per visit, per day, per provider, etc.? A. You may charge up to one copayment per visit per day. Back to top Q. Who will collect the OHP copayments? When will they be collected? A. You will collect the copayment. You may collect it at the time of service or during the regular billing cycle. The OHP Standard benefit package does not have copayments. Back to top Q. What happens if my patient does not pay the required OHP copayment? A. If your patient does not pay the copayment, he or she should see your billing clerk. They can discuss the situation and options. You might decide to set a repayment schedule, waive the copayment, or turn the account over to a collection agency. The OHP Standard benefit package does not have copayments. Back to top Q. Can I refuse to serve OHP patients for not paying their copayments? A. You cannot deny these Medicaid patients services only because they do not pay a copayment. The OHP Standard benefit package does not have copayments. Q. Will my patients have appeal rights if I refuse to give them services because they did not pay the OHP copayment? A. No. Your patient may, however, ask for a hearing if he or she thinks you made a mistake in the amount charged. Your patient may also ask for a hearing if he or she thinks DHS made a mistake in his or her eligibility. This page updated Sept. 2006. |
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