Page 133

5615 Highpoint Dr., Suite 100 Irving, TX 75038-9984 • Telephone: 877-391-7471 • Fax: 469-359-4319 • Email: wicasualty@hms.com If the member is enrolled in an HMO or MCO they must also report the accident or injury to that organization. All other Medicaid members should report in person or phone their local agency and any HMO or MCO that may have provided services before the case is settled. Members should include the date of the accident and any insurance and attorney information. This page last updated in Release Number: 17-03 Release Date: 11/03/2017 Effective Date: 11/03/2017 9.6 Other Health Insurance 9.6.1 Other Health Insurance Introduction The IM agency should collect insurance coverage information about applicants and members at application, review, person add, or when insurance changes and enter it into the Medical Coverage page in CWW. The fiscal agent will complete an insurance search and return verified insurance information through the CWW/MMIS interface. This is because Medicaid is usually the payor of last resort, and any other insurance coverage will be billed before the Medicaid program. 9.6.2 Policies Not To Report The following policies should not be entered on the Medical Coverage page in CWW or reported to the fiscal agent on the Health Insurance Information form (F-10115). 1. HMOs for which the state pays all or part of the premium. 2. Medicare Part A or Part B premiums (entered in CWW on the Medicare page). 3. IHS is the exception to the rule that Medicaid is the payer of last resort. For Native Americans who are Medicaid members, IHS is the payer of last resort. Do not enter these policies in CARES. 4. Policies that pay benefits only for treatment of accidental injury. 5. Policies that may be described as health insurance, but which pay only weekly or monthly based on the insured’s disability. 6. Limited insurance plans that pay only if there is a specific diagnosis, such as cancer policy. Report them only if the person insured has been diagnosed as having the disease he or she are insured against and if the benefits are assignable. 7. Life Insurance. 8. Other types of insurance types that do not cover medical services. This page last updated in Release Number: 20-04 Release Date: 11/23/2020 Effective Date: 11/23/2020