Signature Information for Part C Service Providers Billing Medicaid

As you are aware, there are two lines for signature on the Medicaid Consent for billing paperwork for Part C services. The first line allows Heartland AEA staff to bill Medicaid, and the second allows the State to bill private insurance, as required by law. Sometimes it is difficult to get parents to agree to the second signature for private insurance, or they decline private insurance billing. The guidelines below are recommended when presented with these circumstances: 

(1) If a child has private insurance: Both signature lines are needed in order to bill Medicaid. MJ Care does not bill private insurance, however the State might. If the family refuses to sign the second signature, the provider should make a statement near the signature line that the family has private insurance and chose not to sign. 

(2) If a child does not have private insurance: If the child does not have private insurance, there are a couple of acceptable scenarios. Either the staff can put a statement somewhere near the second signature line such as “The child does not have private insurance” or the family can sign. In either case, MJ Care can bill Medicaid. 

(3) If the second signature is blank, with no statement: Staff is encouraged to complete the consent form with the family at their next opportunity. 

If you have any questions, contact Sara Mercer, School Psychologist, at smercer@heartlandaea.org or ext. 14312.