(f) charge other insurers and third parties, including the Medicare program, prior to the regulation of the MEDICAID program, if the recipient is entitled to payment for health care or related services from another insurer or person and meets all other state and state requirements in this regard. (g) Report and refund all funds received in error or in addition to the amount to which the Provider is entitled under the MEDICAID Program within ninety (90) days of receipt. (h) be liable for and exempt the Agency from any claim, remedy, judgment or damage, including court costs and attorneys` fees, resulting from the provider`s negligence or omission in providing services to a recipient or person who is presumed to be a recipient, to the extent permitted and in accordance with the Section; (2001) and all successor provisions. 96 (2) 97The following forms, included in the Florida Medicaid Provider General Handbook, are added by reference. In Chapter 3, The Temporary Medical Identification Card, July 2008; CF-ES 2681, Notice and Proof of Presumptive Eligibility for Medicaid for Pregnant Women, Feb 2003; CF-ES Form 2014, Authorization for Medicaid/Medikids Eligibility, Feb 2003; Form AHCA 5240-006, Unborn Activation Form, January 2007; CF-ES 2039, Medical Assistance Referral, Sep 2002. Chapter 4, AHCA-Med Serv 038, Crossover with TPL Claim and/or Adjustment Form, July 2008; 178AHCA Form 5000-3527, Medicare Part C-Medicaid CMS-1500 Crossover Invoice, June 2012; form AHCA 5000-3528, Medicare Part C-Medicaid UB-04 Crossover Invoice, June 2012200. Appendix D, 203AHCA Med Serv Form 2000-0016, Medicaid Out of State Prior Prior-Authorization Request, January 2012. 215FC-ES forms are available from the Department of Child and Family Services. Other forms are available on the Medicaid Fiscal Agent238 website at 242www.mymedicaid-florida.com243.
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