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MEDICAL SERVICES POLICY MANUAL, SECTION D

D-500 Mandatory Assignment of Rights to Medical Support/Third Party Liabilities D 540 Procedure for Failure to Cooperate

It is the responsibility of the provider to file a claim for services with Third Party sources and to report the third party and receipt of funds received from the third party when filing a Medicaid claim. When the amount of liability is determined, Medicaid will pay the claim to the extent that payment allowed under the agency’s payment schedule exceeds the amount of the third party’s payment. The provider is to make no claims against a Third Party source for services for which a claim has been submitted to Medicaid.

D-540 Procedure for Failure to Cooperate MS Manual 01/01/14 Recipients who are not cooperating with the Division of Medical Services Third Party Liability Unit will be subject to termination of Medicaid assistance. The Third Party Liability (TPL) Unit will notify the County Office when a recipient has been determined uncooperative. When a notice is received from the Third Party Liability Unit that a recipient is not cooperating, the caseworker will: 1. Complete Form DCO-700 to give advance notice to thenon-cooperating recipient that his/her Medicaid will be terminated due to failure to cooperate. 2. If no response from recipient, remove the non-cooperating recipient from his eligibility group in the system, effective the appropriate date for the eligibility group in which he/she resides (Re. MS A-200). This may require case closure if the recipient is in a one- person household. The recipient who has not cooperated with the Third Party Liability Unit will remain ineligible for Medicaid until TPL determines that the recipient is cooperating. The Third Party Liability Unit will notify the County Office when a case or member can be reopened.