N.Y. Comp. Codes R. & Regs. tit. 18 § 542.3

Current through Register Vol. 46, No. 51, December 18, 2024

Section 542.3 - Assignment of subrogated claims proceeds to providers

(a) If a provider submits a claim for reimbursement to a liable third party in accordance with section 542.2 of this Part, such provider will be entitled to receive and retain, subject to any claim a recipient may have, any payment that is required to be paid to the department as a subrogate of such recipient or a legally responsible relative.

(b) A provider authorized to receive payments in accordance with subdivision (a) of this section is further authorized, as an agent of the department, to direct any liable third party to which claims are submitted in accordance with section 542.2 of this Part to make any payments to which the department is entitled to such provider.

(c) If a provider receives a payment from a liable third party, a recipient or responsible relative and also from the medical assistance program for the same medical care, services or supplies, the provider must return to the medical assistance program the amounts of any medical assistance payments which have also been paid by such third party, recipient or relative.

(d) If a provider receives a payment from a liable third party, recipient or responsible relative for medical care, services or supplies in an amount that is less than that which would be reimbursed by the medical assistance program, the provider may submit a claim for reimbursement to the medical assistance program for the difference between the amount the medical assistance program would pay and the amount actually received by the provider, provided that documentation of the amount received by the provider is submitted with the claim made to the medical assistance program or made available for review as required by the department.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 542.3