(a) Claims will be submitted monthly for each eligible recipient.  A claim for that particular individual should include all reimbursable services provided during a given month.

(b) Claims must not be submitted prior to OHCA’s determination of the client’s eligibility and must not be submitted later than 1 year after the date of service.  If the eligibility of the individual has not been determined after ten months from the date of service, a claim should be submitted in order to assure that the claim is timely filed and reimbursement from Medicaid funds can be made should the individual be determined eligible at a later date.

(c) Claims for dually eligible individuals (Medicare/Medicaid) should be filed directly with the OHCA.