Provider signature of Medical claims - electronic claim form

Provider Signatures

This section discusses the various requirements for provider signatures when filing electronic or hard copy claims.

Medical Claims

The provider's signature on a claim form/medical submission agreement certifies that the services filed were performed by the provider or supervised by the provider and were medically necessary.

Individual practitioners (not groups  or clinics) may sign a medical claims submission agreement with Medicaid for the submission of paper claims instead of signing individual claim forms.

By signing the claim agreement, the provider agrees to keep any records necessary to enable the provider to perform the following responsibilities:

• Disclose the extent of services the provider furnishes to recipients
• Furnish Medicaid, the Secretary of HHS, or the state Medicaid Fraud Control
Unit, upon request, any information regarding payments received by the provider for furnishing services
• Certify that the information on the claim is true, accurate, and complete, and the claim is unpaid
• Affirm the provider understands that the claim will be paid from federal and state funds, and any falsification or concealment of a material fact may be prosecuted under federal and state laws

Providers who have a completed Medical Claims Submission Agreement on file should place the words "Agreement on File" in block 31.

If an agreement is not signed, the individual practitioner must personally sign theclaim form in the appropriate area or initial the claim form beside a typewritten or
stamped signature. An individual practitioner's name or initials may be signed by
another person who has power of attorney from the practitioner.3

Computer Generated Claim Forms

Computer generated claim forms may be submitted with the provider's name generated on the form. In which case, the provider’s handwritten name or initials must accompany the name.

"Agreement on File" may also be printed on computer generated claim forms in lieu of the provider's signature, if a Medical Claim Submission Agreement is on file