Frequently Asked Questions

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Is the Medicaid Managed Care Plan (MMCP) supposed to pay children's HCBS claims that are not submitted properly by the provider, or can they deny these claims?

The remedial Plan of Care (POC) policy includes the significant issues that may be used by the MMCP to determine a children's HCBS claim is invalid and should not be paid. In general, if the claim is valid but cannot be processed for administrative reasons, the plan should pend the claim and work with the provider to correct the claim.

Source: State Released MMCP FAQ Sept 27, 2019