zz – Obsolete

0945.020.00 TEMP Forms – OBSOLETE

TEMP Eligibility Determinations Forms – QP-1
Temporary I.D. CARDS – QP-2

State Office supplies Qualified Providers with TEMP eligibility determination forms, QP-1, and pre-numbered TEMP Temporary Medicaid I.D. cards (QP-2).  State Office keeps controls on which temporary numbers are assigned to each Qualified Provider.  If Qualified Providers contact the county office to request a new supply of QP-1 forms or QP-2 cards, immediately forward the request to State Office, Income Maintenance Section.

The number printed on the card serves as a temporary Medicaid number for the client.  It is the number providers use to bill for medical services provided during the TEMP eligibility period.

When a TEMP eligible woman applies for MC+, use the completed QP-1 form as verification of pregnancy.

The QP-1 form, TEMP card (QP-2), and instructions are included in the Qualified Provider Manual and the IM Forms Manual.