Ala. Admin. Code r. 560-X-20-.03

Current through Register Vol. 43, No. 02, November 27, 2024

Section 560-X-20-.03 - Identification Of Third Party Resources

(1) The Claim - All providers are required to question Medicaid recipients to obtain information about third party resources which may pay for medical services provided to the recipient. All providers must complete third party fields on the Medicaid claim as required in the Alabama Medicaid Provider billing Manual.

(2) Refunds - All third party payments must be applied toward services for which payment was made. These payments may not be applied against other unpaid accounts. If providers receive duplicate payments from a third party and Medicaid, all duplicate party payments must be refunded within 60 days by:

(a) Sending a refund of payment to the Third Party Division, Medicaid; or

(b) Requesting an adjustment of Medicaid payment via Medicaid's fiscal agent.

(3) The Policy File - The Third Party Division, Medicaid, maintains a Policy File which identifies specific coverage provided by a recipient's health insurance. Under limited circumstances good cause may be indicated so that other insurance is not filed.

(4) Eligibility Verification - Third party benefit data is available for inquiry by providers through various resources. Providers should access available systems for third party health insurance information prior to filing Medicaid.

Ala. Admin. Code r. 560-X-20-.03

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 04, January 30, 2015, eff. 2/13/2015.

Author: Wanda Wright, Administrator, Third Party Liability

Statutory Authority:Code of Ala. 1975, § 22-6-6, 42 CFR §§432 and 433; Section 1902(a)(25), Social Security Act.