OKDHS - OAC 317:35-7-15. Application for Medical Services; forms

317:35-7-15. Application for Medical Services; forms

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Revised 3-1-10

(a) Application. An application for Medical Services consists of the Medical Assistance Application. The application form is signed by the individual, parent, spouse, guardian or someone else acting on the individual's behalf. A individual does not have to have received a medical service nor expect to receive one to be certified for SoonerCare.

(1) An application may be made in a variety of locations, for example, a physician's office, a hospital or other medical facility or in the county OKDHS office. An application may be made online by individuals who are pregnant, have children or are applying for family planning services only. A face to face interview is not required. SoonerCare applications for women who are pregnant, families with children and for family planning services only are mailed to the OHCA Eligibility Unit. Applications for other medical services may be mailed or faxed to the local county OKDHS office. If faxed, it is not necessary to send the original application. When an individual indicates a need for health benefits, the physician or facility may forward an application or 08MA005E (.pdf, 3 pp, 154 KB) to the OKDHS county office of the patient's residence for processing. The physician or facility may forward an application or 08MA005E (.pdf, 3 pp, 154 KB) for individuals who are pregnant, have children or are applying for family planning services only to the OHCA Eligibility Unit for processing. If the applicant is unable to sign the application, someone acting on his/her behalf may sign the application.
(2) OKDHS form 08MA005E (.pdf, 3 pp, 154 KB), Notification of Needed Medical Services, is required only for preauthorization of medical services. Although not required, the form may be submitted by the physician or facility as notification for a need for medical service. The form also may be accepted as medical verification of pregnancy.
(3) Receipt of the SoonerCare Application form or OKDHS form 08MA005E constitutes an application for SoonerCare.
(4) If OKDHS form 08MA005E (.pdf, 3 pp, 154 KB) is received and an application cannot be completed, receipt of OKDHS form 08MA005E (.pdf, 3 pp, 154 KB) constitutes an application which must be registered and subsequently denied. The applicant and provider are notified by computer-generated notice.
(5) If the applicant also wishes to apply for a State Supplemental Payment, either the applicant or his/her guardian must sign the Medical Assistance Application form. • 1

(b) Date of application. When an application is made online, the date of application is the date the application is submitted online. When application is made in the county office, the date of application is the date the applicant or someone acting on his/her behalf signs the application form. When the application is initiated outside the county office, the date of application is the date the application or OKDHS form 08MA005E (.pdf, 3 pp, 154 KB) is stamped into the OHCA Eligibility Unit. When an application is faxed, the application date is the date the fax is received. When a request for SoonerCare is first made by an oral request to the county office, and the application form is signed later, the date of the oral request is entered in "red" on the application form above the date the form is signed. The date of the oral request is the date of application to be used. When OKDHS form 08MA005E (.pdf, 3 pp, 154 KB) is received in the county office or the OHCA Eligibility Unit prior to the completion of the application form, the date that OKDHS form 08MA005E (.pdf, 3 pp, 154 KB) is received is considered as the date of application and must be registered as an application. Certain providers may take applications and then forward them to the OKDHS county office or the OHCA Eligibility Unit for SoonerCare eligibility determination. Under this circumstance, the application date is the date the member signed the application form for the provider.

INSTRUCTIONS TO STAFF 317:35-7-15

1. If an individual is certified for a money payment and received medical services in any of the three months prior to the month of application, if the worker chooses to set up a separate case for those months, a copy of the application must be filed in that case.

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