016.06.07 Ark. Code R. 007

Current through Register Vol. 49, No. 9, September, 2024

Rule 016.06.07-007 - State Plan Transmittal #2007-010 and Section III of all Medicaid Provider Manuals

Section III Provider Manual Update Transmittal

331.000Introduction

The Medicaid Program is required by federal regulations to access all third party payment sources and to seek reimbursement for services that have also been paid by Medicaid. "Third party" means an individual, institution, association, corporation or public or private agency that is liable for payment of all or part of the medical cost of injury, disease or disability of a Medicaid beneficiary. Arkansas Code Annotated § 20-77-306 incorporates the requirements of the federal Deficit Reduction Act of 2005 (DRA).

Examples of third party resources are:

A. Medicare (Title XVIII) including Medicare Advantage Programs

B. Railroad Retirement Act

C. Insurance Policies (including insurance carried by an absent parent) such as:

1. Private health

2. Group health

3. Liability

4. Automobile, including casualty, medical payment, uninsured motorist, bodily injury coverage, and underinsured benefits except benefits payable for or limited under the terms of the policy to property damage or wrongful death

5. A Managed Care Organization

6. A Pharmacy Benefit Manager

7. Indemnity

D. Worker's Compensation

E. Veteran's Administration

F. TRICARE (formerly known as CHAMPUS)

G. Social Security Disability Determination

H. Self-insured plans

I. Other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service

Medicaid regulations concerning dual Medicare/Medicaid eligibility (including QMB) and coverage differ from the rules regarding other third party payers and coverage. See section 133.300, 302.100 and 331.000 for additional information.

Arkansas Rehabilitation Services (ARS) is not a third party source. If ARS and Medicaid pay for the same service, refund ARS.

Indian Health Services is not a third party resource.

016.06.07 Ark. Code R. 007

9/10/2007