Common use of BENEFICIARY ELIGIBILITY Clause in Contracts

BENEFICIARY ELIGIBILITY. Contractor shall maintain and implement policies and procedures to ensure a client is a Yolo County Medi-Cal beneficiary, track authorizations, and include only those service units with authorized daily transactions together with the client name for those units eligible for reimbursement. Contractor shall determine Medi-Cal eligibility and report any obligation and payment made of share of cost. Contractor shall provide copies of Medi-Cal swipes documenting beneficiary eligibility with monthly claims. Beneficiaries will be checked weekly by Contractor to verify they are still entitled to Medi-Cal services. If a beneficiary is no longer authorized for service but is in an approved course of treatment, then Contractor shall notify the County in writing immediately. Service may be rendered on a one-time-only basis if the beneficiary’s status has changed since the last service. Additional services may be provided only with the Director’s written authorization based on individual case treatment/service needs.