California Hires Private Company to Pursue Medicaid Reimbursement

California's Department of Health Care Services has contracted with a private sector company, Health Management Systems, to seek information from workers' comp payers on possible reimbursement recoveries to the state through Medicaid.

The department has sent letters to workers' comp payers through its Third Party Liability and Recovery Division, informing of its contracts with Health Management Systems and requesting assistance with data matches between the companies' subscriber files and DHCS eligibility files.

According to the DHCS website, the issue falls under its Workers' Compensation Recovery Program, which "is responsible for identifying and recovering Medi-Cal expenditures made on behalf of beneficiaries whose injuries are covered by workers' compensation liability."

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It says the program contracts with vendors who "recover Medi-Cal funds and receive a fixed percentage of the amount of recoveries collected for the state."

Included on the website is a workers' compensation referral form that can be submitted to either the DHCS or HMS. Titled, Potential Third Party Liability Notification, it seeks information from patients on whether they've used Medi-Cal and where the injury occurred. For those whose injuries are work-related, the form asks whether the patient has filed an application for workers' comp benefits.

Read more at the WorkersComp Forum homepage.

March 28, 2011

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