Healthcare Financial Services, LLC - Professional Collections and Telemarketing.

MISSISSIPPI MEDICAID

If you are a Medicaid recipient, please provide us with your Medicaid Identification number so we may submit your claim for payment. In the State of Mississippi, claims must be submitted within one year from the service date.


Patient Name:
Phone Number:
Email:
Client Account # (see letter):
Medicaid Identification (CIN#):
Date of Birth (MM/DD/YYYY):

If you have Medicaid in a State other than Mississippi, please provide the following information:
State:
Medicaid ID #:
Insurance Carrier :
Insurance Address :
City:
State:
Zip:
Insurance Phone:
Effective Date (MM/DD/YYYY):

If you do not have a current Medicaid card and you received In-Patient hospital services and believe you may be eligible, please call your hospital to determine eligibility. Please note that your treatment date MUST be within the last 90 days in order to apply. In order to assess POSSIBLE eligibility, you will have to answer detailed questions on the following topics for all household members:

Earnings
Bank accounts
Other resources (alimony, child support, trust funds)
Expenses (rent, car, food)

If you have potential eligibility, you can apply for benefits through your local Department of Social Services Office, or we can assist you in the application process.

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