Medicaid is a program run by the federal government that provides needy families and individuals with healthcare they could not afford themselves. Medicaid healthcare providers are important to the system, because they take on patients may not get care if another doctor refuses to accept Medicaid.

To take Medicaid patients in your practice, you'll need to know your way around the Medicaid system, know how someone qualifies, and how the program is run from state to state. There are many Medicaid key terms that can help you better understand the system. Most of the key terms are related to subjects like:

1. The Medicaid eligibility of a child, adult or family.

2. Which Medicaid insurance programs are available for these families.

3. Any special terms that apply to specific states.

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Know the terms common to the Medicaid application process

Healthcare providers usually work with those who have already qualified for the Medicaid program, but it's useful to know what the qualifications are in your state. Medicaid eligibility is different for people depending on where they live. Indiana Medicaid, for instance, is a lot different than Texas Medicaid when it comes to eligibility.

I recommend: The US Department of Health and Human Services provides a glossary of common terms that can help you learn more about the Medicaid program on a national level. Texas Medicaid also has its own set of glossary terms.

Learn more about what types of Medicaid programs are available in your state

You should be aware of of your state's particular regulations for Medicaid, so you know what kind of services you can offer to your Medicaid patients.

I recommend: The National Alliance on Mental Illness provides key terms about the types of programs and services available through Florida Medicaid, as well as other state programs that might be of service to those working with mentally ill patients. Most state Medicaid programs list their services on their website, like Illinois Medicaid does.

Explore which Medicaid programs qualify patients for free or reduced priced medication

When working with a Medicaid patient, healthcare providers should also be aware of what qualifies a Medicaid patient for free or reduced medication. This is a helpful way to avoid problems later on, should patients not receive or take cost-prohibitive medication

I recommend: Alabama Medicaid has a variety of programs that allow Medicaid patients to apply for assistance with prescription costs. The Kaiser Family Foundation also has a lot of information on different prescription programs available to Medicaid healthcare providers.

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Helpful advice for making the most of this Guide

• •  Choosing to accept Medicaid will provide you with many new patients. Now with reforms in Medicaid reimbursement, healthcare providers can receive Medicaid payments faster than ever.

Medicaid is a federally run program to help needy individuals and families receive quality healthcare. If you recently decided to become a Medicaid healthcare provider so you can serve clients with Medicaid insurance, you will need to take steps to be eligible for Medicaid reimbursement for services. By opening up your business to Medicaid insurance recipients, you will make it possible for needy families and children, seniors over 65 years old, individuals with a disability and pregnant women to receive your services.

Each state has its own Medicaid program and the Medicaid eligibility requirements differ state to state. Applying as a Medicaid provider also varies state to state, so applicants need to complete the correct application for their state of business. When setting up your business for Medicaid insurance recipients you will need to:

1. Apply for a Medicaid provider identification number for your business.

2. Establish a Medicaid compliance program to remain in accordance with Medicaid regulations.

3. Submit Medicaid claims for reimbursement of services.

Action Steps
The best contacts and resources to help you get it done

Apply for Medicaid provider identification number

All states require businesses that would like to provide services to Medicaid recipients to apply for an identification number. The application process may take up to 30 days. You will need this number for all paperwork submitted to Medicaid for payment.

I recommend: For Texas Medicaid providers, an online application is available to you at the Texas Medicaid and Healthcare Partnership. Florida Medicaid providers must print, complete and submit the Medicaid enrollment application form from the Florida Alcohol and Drug Abuse Association. Mississippi Medicaid and Georgia Medicaid providers can apply online at the National Plan and Provider Enumeration System.

Implement a Medicaid compliance program

Medicaid requires detailed records of all services provided to Medicaid insurance recipients. To receive reimbursement for the services you provide, you must have all documentation up to date with Medicaid regulations. These regulations change often so it is imperative to stay on top of any updates.

I recommend: Learn about starting a Medicaid compliance program in your office at the American Academy of Family Physicians website. Some companies such as The Bureau of National Affairs (BNA) offer services to businesses to help them with their Medicaid compliance program. For up to date information on Medicaid regulations, order the Medicaid Compliance News publication.

Submit Medicaid claim forms for reimbursement of services

To receive reimbursement for services you need to complete Medicaid claim forms and submit them directly to Medicaid. Some states allow you to submit forms electronically, while others still require you to send in the documents.

I recommend: Find information about how to fill out claims submittal forms and the forms themselves at the Texas Medicaid and Healthcare Partnership website. Georgia Health Partnership has a listing of all of their claim forms and information on how to complete them. Mississippi Envision has a website dedicated to providers with information on billing. Florida businesses can find claim submittal information as well as forms for authorization of services at Florida Medicaid.

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Helpful advice for making the most of this Guide

• •  As a Medicaid provider, you may have employees working with your clients that are not Medicaid authorized providers. These employees must be supervised by a Medicaid authorized provider for service reimbursement by Medicaid.

Medicaid is program that was created as part of the Social Security Act in 1965 to provide health care assistance to qualifying participants. Medicaid Insurance benefits children, seniors and people in low-income households, among others. Health care providers and business need to be Medicaid certified in order to provide assistance and bill Medicaid health care insurance.

Health care workers and providers need to be certified within their state guidelines to provide assistance. Each state certification process is different, so nurses certified for Florida Medicaid might not be certified for Texas Medicaid. Medicaid Education and Training should include the following:

1. Learn the process to become a certified Medicaid provider.

2. Learn about Medicaid certification by state.

3. Understand the Medicaid certification guidelines for health care workers and providers.

Action Steps
The best contacts and resources to help you get it done

Learn how to become a certified Medicaid provider

Nurses, health care providers and health care facilities must be Medicaid certified in order to provide help to Medicaid members. As a health care provider, it's important to become trained and certified through Medicaid to provide adequate care and assistance. Learn how to become certified and educated about the federal and state Medicaid programs.

I recommend: Begin training by completing this online training course offered by MedicaidTraining.org to learn about the federal Medicaid program. The Georgia Health Partnership provides a comprehensive group of guides designed to educate health care providers about all the programs and policies of Georgia Medicaid.

Get Medicaid certification through different state programs

Medicaid certification requirements vary from state to state. Health care providers need to be educated both about the federal certification process, but also to gain Medicaid eligibility for certification within their own state regulations. Learn how to become Medicaid certified as a health care provider within your home state.

I recommend: Complete the Medicaid training program at the Center for Development of Human Services at the Research Foundation of SUNY, Buffalo State College. Get Medicaid healthcare training from the program on Florida Medicaid's website.

Research Medicaid certification guidelines

Medicaid providers have to be certified by federal and state Medicaid programs to provide members with health care services such as checkups or billing for prescriptions and medical equipment. Health care workers and facilities need to be educated about the guidelines for this certification process.

I recommend: Use online seminars and books like this one provided by CMS to learn about Indiana Medicaid provider accreditation. You can apply for on-site assistance to learn about compliance and guidelines. Use the downloadable toolkit training guide from NCQA to learn more about Medicaid certification and accreditation for Medicaid providers in Illinois and other states.

Tips & Tactics

Helpful advice for making the most of this Guide

• •  Apply for Medicaid insurance certification in the state that you live before getting certified in other states.