Retroactive eligibility definition

Retroactive eligibility means the period of time consisting of the three months preceding the month in which an application for Medicaid is filed, during which the person may be eligible for Medicaid coverage as determined by the department.
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Retroactive eligibility. Members who have an eligibility period that is only retroactive.  PACE: Members who are enrolled in the Program of All-Inclusive Care for the Elderly (PACE) benefit.
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Retroactive eligibility means that if payment for past medical expenses is requested, and eligibility exists, retroactive medical assistance may be approved.
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Examples of Retroactive eligibility in a sentence

  • When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor shall not deny payment for medically necessary covered services for lack of prior authorization or lack of referral.

  • The Contractor shall ensure determinations for Retroactive Eligibility Reviews are completed ninety-eight percent (98%) of the time within twenty (20) business days of receipt.

  • The Contractor shall have the capability and established procedures to receive Retroactive Eligibility Review requests.

  • The Contractor shall determine the medical necessity for non-inpatient hospital medical services authorizations, Retroactive Eligibility Reviews and Retrospective Reviews to eligible Mississippi Medicaid beneficiaries utilizing the Division’s approved criteria and policies.

  • The Contractor shall determine the medical necessity for emergency and non- emergency inpatient hospital admission prior authorizations, continued stays, Retroactive Eligibility Reviews and Retrospective Reviews for inpatient medical/surgical services to eligible Mississippi Medicaid beneficiaries utilizing the Division’s approved criteria and policies.

  • Retroactive Eligibility Section 1902(a)(34) To enable the Commonwealth not to provide retroactive eligibility for up to 3 months prior to the date that the application for assistance is made and instead provide retroactive eligibility as outlined in Table D, section V.

  • When Retroactive Eligibility and Retrospective Reviews requests are necessitated, the Contractor must not deny payment for medically necessary covered services for lack of prior authorization or lack of referral.

  • Gross earnings must meet the threshold test $2,000 individual $3,000 couple DSHP SSI Child or Adult n/a X State Plan Mandatory Medicaid Eligibility Groups Description FPL Resource Standard Medicaid Eligibility Group (MEG) Retroactive Eligibility Procedures DSHP Benefit Package DSHP- Plus Benefit Package* Alternative Benefits Plan Package for section 1619(b) eligibility.

  • Retroactive Eligibility for Medicare The Department or its designee will notify the CONTRACTOR when Medicaid Managed Care Members become retroactively eligible for Medicare.

  • Retroactive Eligibility, Comparability, Cost Sharing Requirements, Freedom of Choice Population 8 Demonstration Expansion Groups FPL and/or Other Qualifying Criteria Applicable Waivers and CNOMs (See Waiver List Summary) Demonstration Population (See STC 62 ) Xxxxxx Parents (ages 19-64) (Employer Sponsored Plan) Up to and including 200% FPL, who work full-time or part-time for an eligible employer.


More Definitions of Retroactive eligibility

Retroactive eligibility means that if payment for past medical expenses is requested, and eligibility exists, retroactive medical assistance may be approved.[ The Department of Social Services, Office of Community Operations, will determine the eligibility.]
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Related to Retroactive eligibility

  • Salary reduction plan means a benefit plan whereby state and

  • Eligible Earnings means the Grantee's base salary (prior to any deferrals under a cash or deferred compensation plan sponsored by the Corporation or an Affiliate) paid during the Plan Year. From time to time the Plan Administrator may, in its sole discretion, establish rules for determining the amounts of Eligible Earnings for employees who become Grantees other than on the first day of a Plan Year as well as any reduction of Eligible Earnings as a result of paid leave of absences.

  • Eligibility Waiting Period means the continuous length of time you must be in Active Employment in an eligible class to reach your Eligibility Date.

  • Deferral Election means the Participant’s election under Section 3.1 to defer all or a portion of his or her Compensation.

  • Covered Termination means the termination of Executive’s employment by the Company without Cause or by Executive for Good Reason, and shall not include a termination due to Executive’s death or disability.

  • Date of Service means the date on which the client receives medical services or items, unless otherwise specified in the appropriate provider rules. For items that are mailed or shipped by the provider, the date of service is the date on which the order was received, the date on which the item was fabricated, or the date on which the item was mailed or shipped.