Case Study: Verifying Medicaid Eligibility

Verifying Medicaid Eligibility

Patient: Jin
Sex: Male
Age: 6 years

Jin recently moved to your town with his parents after the family’s home was flooded. The family lost most of their possessions, including their health records, and relocated to live with relatives. Jin’s mother scheduled an appointment for her son’s preventive medical checkup and said she wants to make sure his immunizations are up to date so he can enter the local school. When she arrives with Jin, she does not have proof of the boy’s Medicaid coverage, the name of his health plan, or his immunization records.

What options do you have to verify Jin’s eligibility for Medicaid services and provide services today?

YourTexasBenefitsCard.com Provider Portal

The YourTexasBenefitsCard.com provider portal allows you to verify Jin’s Medicaid eligibility and his health plan, view available health information such as immunization records, past medical visits including Texas Health Steps checkups, as well as various screenings, treatments and clinical diagnosis. You can also print a copy of Jin’s Your Texas Benefits Medicaid Card for his mother.

The portal provides access to available health information for patients covered by Medicaid managed care and fee for service.

Medicaid providers and office staff must create an account before using the secure site, or access through selected MCO online portals.

https://www.yourtexasbenefitscard.com/

Medicaid Automated Inquiry System

The Medicaid Automated Inquiry System allows you to check Jin’s eligibility for FFS Medicaid. The phone system can be reached at 1-800-925-9126. In addition to verifying Jin’s eligibility, you can check the status of claims and benefit limitations.

Download PDF

Medicaid MCO online portals

Medicaid managed care organizations (MCOs) maintain online portals where network providers can access patient information. If Jin is covered by an MCO, you can consult the plan’s manual or contact the plan directly for information about his benefits.

Why it Matters

Your knowledge about options for verifying Jin’s eligibility can ensure the boy receives required health services on schedule and can help him and his family make a healthy transition, all while improving workflow and efficiency in your office.

Check out the Related Courses listed below to learn more about about providing Medicaid services to Texas children and adolescents.

About Texas Health Steps

Texas Health Steps’ award-winning online program offers FREE CE courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory, and best practice guidelines for a range of preventive health, oral health, mental health, and case management topics.