MEMORANDUM

2013 Memorandums

IM-#21      03/01/13

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
REQUEST FOR PARTICIPANT MO HEALTHNET REIMBURSEMENT FORM (IM-64) REVISED
FORMS MANUAL REVISION #10

DISCUSSION:

The purpose of this memorandum is to introduce the revised Request for Participant MO HealthNet Reimbursement form (IM-64) and instructions. The IM-64 is updated to use current terminology and to allow reimbursement requests based on monthly spend down eligibility rather than quarters. This form is used to notify the MO HealthNet Division when a claimant is requesting reimbursement for incorrectly denied medical expenses that were paid by the claimant. The IM-64 should be completed when:

The revisions include:

NECESSARY ACTION:

AC/KS/VB


2013 Memorandums