(a) When an individual not currently eligible, including Medicare eligible individuals, requests the physician and/or hospital to bill the Authority for medical services, Form MS-MA-5  (.pdf, 2 pp, 19 KB) (new Form 08MA005E), Notification of Needed Medical Services, may be completed by the physician and a designated representative of the facility which is to provide the medical services or the patient, parent or guardian may make application by completing an Application for Medical Services.  The original forms are routed to the Oklahoma Department of Human Services office in the county of the patient's residence for determination of eligibility.  The date of the application is the date the first form received is stamped into the local OKDHS county office.  If the patient is in the hospital, application should be made while the patient is still in the hospital, if at all possible.

(b) For pregnant women requesting medical services, Form MS-MA-5 (.pdf, 2 pp, 18 KB) (new Form 08MA005E) is not required, but will be accepted as medical verification of pregnancy.  If Form MS-MA-5 (.pdf, 2 pp, 18 KB) (new Form 08MA005E) is not completed, a letter or written statement from the physician or certified nurse midwife is acceptable.  Pregnancy may also be verified by submission of a copy of a laboratory report indicating the individual is pregnant. The expected date of delivery must also be established.  This can be established from either medical information from the physician or nurse midwife or, in absence of these reports, the applicant's statement.