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What do you do if your Client is involved in an accident?
Ask your client if they are covered under Medicaid, Peach Care for kids or the State Health Benefit Plan. You may contact our office and verify if your client is covered under any of the above programs.
What are the attorney's responsibilities?
The Medicaid application is a binding legal document. When a member signs this application he or she acknowledges that medical benefits paid on his or her behalf must be reimbursed to the Department if he or she is also entitled to benefits from a third party.Official Code Georgia §9-2-21, requires the attorney or legal representative who is aware of their client receiving benefits shall notify the Dept. of Community Health prior to initiating a tort recovery action. Notification is easy; a simple phone call to (770)980-9777 takes care of it. You may also notify the Subrogation Unit in writing of your representation via U.S. mail or the transmittal form can be faxed to (770) 937-0180 or submitted via the website.
What will the Subrogation Unit do for you and your client?
Upon contact by an attorney's office, the Subrogation Unit will establish the member's eligibility status at the time of the accident, determine whether the program incurred any medical expenses as a result of the accident or injury and generate a complete medical history of claims filed on behalf of the injured party. This information is available to attorneys who submit a written request along with a signed medical authorization from the client granting the attorney access to their medical records.
What costs are recovered?
The Subrogation Unit will request reimbursement for injury related charges only. An injury/loss may include, but are not limited to an auto accident, medical malpractice, general liability, and worker's compensation.In most cases, Medicaid pays less than the amount of the submitted charges. What happens to the difference? Contractually, the provider must accept Medicaid's payment as payment in full and cannot balance bill the customer for the difference. In seeking reimbursement, Medicaid can only legally claim repayments up to the amount that it has expended. This is another good reason to contact the Subrogation Unit. Once a provider has submitted claims for adjudication, the provider must accept Medicaid's payment. By requesting a detailed list of the claims paid by Medicaid, you can ensure that your customer is not paying a claim twice or at a higher rate. Medicaid is payor of last resort . Where a private insurance exists, any and all other monies should be utilized before Medicaid provides any assistance.
What happens if the member fails to pay the Department's interest?
- May impact present and future Medicaid eligibility
- Leaves outstanding Medicaid and Peach Care for kids lien
How does the State Health Benefit Plan Subrogation Plan work?
The Plan may pay medical expenses if you or a dependent is injured due to the alleged negligence or misconduct of another party. If the other party or their insurance company also pays you for the same medical expenses, the Plan has the right to recover the money it has paid to you. The right of recovery is called subrogation.
You must furnish the Plan with any information or assistance needed to carry out the non-duplication of benefits and subrogation policies. Also, you can not take any action that might keep the Plan from exercising either of these rights.
How do you repay the Department of Community Health?
It is simple, just make your check payable to the Georgia Department of Community Health and mail it to P.O. BOX 38439 , Atlanta GA 30334-9985 . We look forward to hearing from you soon.
