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It is critical to contact HCA both at the beginning of the case and then again when you are negotiating settlement. Providers have up to one year from their date of service to bill HCA.
Even if HCA does not have a subrogated interest at the beginning of a case, claims may have received by the time the case is ready to settle, which must be paid from the settlement. Don't get delayed: We recommend that you include only one client per correspondence.
For compliance, we must redact all correspondence referencing more than one client. Multiple clients on the same communication may result in a delay. To expedite your request, include the following information on your letter of representation. This information helps us determine if we have a subrogated interest.
You have three options for sending your letter of representation and current HIPAA compliant authorization. We process requests in the order of date received. Allow at least 10 business days for a response. If you have waited 20 days and have not received a response, resubmit your request. Note: Providers have up to one year from their treatment date of service to bill the agency for any charges. With recent accidents, there may not been enough time for insurance companies, MCOs, and HCA to receive and process claims from providers.
If the client received any treatment or required any emergency transportation such as ambulance or airlift, there will likely be subrogation at some point. Any requests for reductions beyond our proportionate share should include the documents listed above and be sent directly to our Torts Recovery Advisors. Note: If you prefer to forgo the aforementioned documentation and choose to remit the full amount due, then a written statement waiving the reduction is required.
Any checks received without following the above process, will be placed on hold until the required documentation is received. If your client has been incarcerated and received injury related medical treatment there may be subrogation with Department of Corrections DOC as well. It is important that you notify us of any change of address for your firm or insurance company as soon as possible. This also includes any changes to the firm's name, attorney's name, email, and phone or fax numbers.
If a person is placed in a managed care plan, Apple Health pays for the client's managed care premiums, and most of their health care services are paid through the plan. However, some services are still paid by Medicaid even when the client has a managed care plan. That's why the HCA may have a subrogated interest in addition to the managed care plan's subrogated interest.
You will work with HCA every time a client has Medicaid. If there is a managed care plan, you will also have to work with the plan. When you contact us regarding subrogation claims, and the client is in a managed care plan, we send you a letter to inform you which plan s the client is in. You will contact plan s directly regarding their subrogated interest. As the attorney representing these clients you will need to contact both our office and the managed care organization MCO to satisfy everyone's interest.
There are certain times during the handling of a case when you are required to contact the HCA. See RCW All plans have hired a vendor for their subrogation work.
Toll Free: Fax: Website: www. Molina Healthcare of Washington, Inc. Toll free: Fax: Email: subrogationreferrals optum. In an effort to make health coverage more affordable and accessible to all eligible clients that live in Washington, the HCA contracts with MCOs. HCA pays the client's monthly premium and any carve-outs not covered by their managed care plan.
In those cases, the managed care plan becomes the primary payer and we become secondary for any noncovered services. It has a nine-digit number that starts with a 1 or a 2 and all of our ID numbers end with WA. If a client has a managed care plan, they will have an additional insurance card with an ID number for that MCO.
Your benefits are conveniently loaded on your card so you shop the same way as you do for over-the-counter products and scan your barcode for instant savings! For questions about eligibility or how to enroll for Assistive Devices or Service Dog Support, please call the number on the back of your health plan card.
Once you're logged in, you can easily find your account balance listed at the top of the About page or under Benefit Details on the mobile app. You can also use your catalog to view eligible products. You have three easy ways to shop: online, in-store at a participating store location, or over the phone. Best of all, all shipping costs are waived for members and will not be deducted from your benefit balance. They are fully covered by your health plan at checkout.
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You can use your benefits to purchase OTC items including allergy medication, cough drops, first aid supplies, oral care, pain relievers, vitamins and more! With Assistive Devices, you can use your benefits to purchase grab bars, bath chairs, hand showers, hearing amplifiers, low vision aids, dressing aids, portable ramps and more! With Service Dog Support, you can use your benefits to purchase dog food, feeding supplements, bowls, dog brushes, harnesses, leashes, training pads and more!
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WebWith access to your secure account, you can: Change your primary care provider. View or print your member ID card. Manage your CarelonRx Pharmacy prescriptions, if applicable. Update your contact info. Chat with a live person or send us a secure message. Request a call back from Member Services. You will need your member ID number to register. WebTo order over the phone, find the products you want to order in the catalog and call , TTY You will need the approved item name(s), item ID(s), your OTC card number and security code, and your shipping address to place the order. WebCreate Your Online Account By creating your secure member account, you can: Change your primary care provider (PCP). View or print your member ID card.