Lien Recovery for Settlements

Third party payments include health insurance benefits, settlements or court awards for casualty/tort (accident) claims, product liability claims (global settlements), medical malpractice, worker’s compensation claims, etc. 

Third party liability (TPL) is the legal obligation of health care carriers to pay for all, or part, of a medical claim of a Medicaid beneficiary. By law, Medicaid is generally the payer of last resort, meaning that Medicaid only pays claims for covered items and services if there are no other liable third party payers. 

Medicaid is used to refer to Fee-for-Service (FFS), and IA Health Link.  

Iowa's managed care program, officially named IA Health Link, started April 1, 2016. The majority of Medicaid members transitioned to a Managed Care Organization (MCO) on this date.

Currently, the IA Health Link program is administered by two MCOs: Iowa Total Care* and Amerigroup, Iowa. These MCOs provide Medicaid members with comprehensive health care services, including physical health, behavioral health, and long-term services and support.

There is a small percentage of Medicaid members that are not assigned to an MCO, and receive health care services through the Fee-for-Service (FFS) program. In these cases, injuries on or after April 1, 2016, continue to be reported to the Iowa Medicaid Enterprise (IME) Revenue Collections Unit. For all other cases, the attorney's office or health care carrier must work with the member's MCO.

*Iowa Total Care joined the IA Health Link program effective July 1, 2019. UnitedHealthcare ceased to be part of the IA Health Link program on June 30, 2019.

 

Examples of the impact for injuries and lien recovery

  • If an injury happened prior to April 1, 2016, the IME Revenue Collections Unit will file a lien for services incurred before April 1, 2016.

  • If an injury results in claims that include services incurred prior to and after April 1, 2016, the IME Revenue Collections Unit will file a lien for any health service payments related to the injury and incurred prior to April 1, 2016. A service related to the injury on or after April 1, 2016, will be handled by the member’s MCO. The MCO will file a separate lien for services incurred on or after April 1, 2016.

  • For injuries that occur on or after April 1, 2016; if the member has the Medicaid FFS, the IME Revenue Collections Unit will file a lien for services prior to their MCO assignment. If the member moves their eligibility to an MCO then the member’s MCO will handle liens for any services incurred after assignment. In instances such as this, the attorney’s office or carrier will need to work with both the IME Revenue Collections Unit and member’s MCO.

 

Medicaid will request more information from a member when a provider submits a claim for payment that shows the Medicaid member may have been involved in an accident or injury.  Medicaid members who do not return the requested information may lose their Medicaid coverage. Once Medicaid coverage is lost any months that are lost due to non-cooperation are not eligible for Medicaid coverage. To regain Medicaid eligibility, you may need to reapply for Medicaid.

 

Lien Recovery Contact Information for Settlements

Amerigroup:

  • Toll-Free Phone Number: 844-410-6891
  • Fax Number: 844-634-2520
  • Email: mrcadmin@meridianresource.com
  • Operating Hours: 7:30 a.m. to 7:00 p.m.
  • Mailing Address for Questionnaires Only: PO Box 659505, San Antonio, TX  78265-9916
  • Mailing Address for Subrogation Correspondence: PO Box 659940, San Antonio, TX 78265-9939

 

Iowa Total Care (Contact The Rawlings Group):

  • Toll-Free Phone Number: 888-285-1276
  • Phone Number: 502-587-1279
  • Fax Number: 502-440-1100
  • Email: CenteneReferrals@rawlingscompany.com
  • Operating Hours: 8:00 a.m. to 5:00 p.m. Monday through Friday
  • Mailing Address: 1 Eden Parkway, La Grange, KY  40031

 

Iowa Medicaid (Fee-for-Service):

  • Toll-Free Phone Number: 866-810-1206
  • Local Phone Number (Des Moines Area): 515-256-4619
  • Fax Number: 515-725-1352
  • Email: Revcol@dhs.state.ia.us
  • Operating Hours: 8:00 a.m. to 4:30 p.m. Monday through Friday
  • Mailing Address: PO Box 36475, Des Moines, IA  50315

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