INSTRUCTIONS TO STAFF 340:75-13-75
1. Title IV-E eligibility documentation. The Child Welfare (CW) specialist:
(1) provides Title IV-E eligibility information with the initial Interstate Compact on the Placement of Children (ICPC) request sent to the Children and Family Services Division (CFSD) ICPC deputy compact administrator; and
(2) screen prints the child's Title IV-E eligibility from KIDS and files it in the KK paper case file.
2. Out-of-state medical services. When a child in OKDHS custody requires medical attention while traveling through or vacationing in another state and the medical provider is not an Oklahoma Medicaid provider and is not willing to become one, the CW specialist:
(1) contacts the medical provider to obtain completed universal medical claim forms:
(A) CMS-1500, Health Insurance Claim Form;
(B) Form UB-04; or
(C) Form CMS-1450;
(2) obtains the provider billing information including the provider's name, address, Federal Employer Identification number (FEI), or tax identification number;
(3) provides Children and Family Services Division (CFSD) Administrative Services Unit with an explanation of the circumstances including the:
(A) reason for the child's out-of-state travel;
(B) dates of the child's travel; and
(C) date of the child's medical services; and
(4) mails the original claim form to CFSD Administrative Services Unit.