Requirements of 3rd parties.
(ac)#
As a condition of doing business in this state, a 3rd party shall do all of the following: 1. Upon the department’s request and in the manner prescribed by the department, provide information to the department necessary for the department to ascertain all of the following with respect to a recipient: a. Whether the recipient is being or has been provided coverage or a benefit or service by a 3rd party. b. If subd. 1. a. applies, the nature and period of time of any coverage, benefit, or service provided, including the name, address, and identifying number of any applicable coverage plan. 2. Accept assignment to the department of a right of a recipient to receive 3rd-party payment for an item or service for which payment under medical assistance has been made and accept the department’s right to recover any 3rd-party payment made for which assignment has not been accepted. 3. Respond to an inquiry by the department concerning a claim for payment of a health care item or service if the department submits the inquiry less than 36 months after the date on which the health care item or service was provided. 4. If all of the following apply, agree not to deny a claim submitted by the department under subd. 2. solely because of the claim’s submission date, the type or format of the claim form, or failure by a recipient to present proper documentation at the time of delivery of the service, benefit, or item that is the basis of the claim: a. The department submits the claim less than 36 months after the date on which the health care item or service was provided. b. Action by the department to enforce the department’s rights under this section with respect to the claim is commenced less than 72 months after the department submits the claim.
(ac)(1)#
Upon the department’s request and in the manner prescribed by the department, provide information to the department necessary for the department to ascertain all of the following with respect to a recipient: a. Whether the recipient is being or has been provided coverage or a benefit or service by a 3rd party. b. If subd. 1. a. applies, the nature and period of time of any coverage, benefit, or service provided, including the name, address, and identifying number of any applicable coverage plan.
(bc)#
A 3rd party shall accept the submission of claims from the department under par. (ac) 2. in electronic form and shall timely pay the claims in the manner provided in s. 628.46 (1) and (2). For purposes of timely payment of claims under this paragraph, “written notice” under s. 628.46 (1) includes receipt of a claim in electronic form.