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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
9.2.1 Nursing Home and Hospital Insurance Introduction
All members must cooperate in providing Third Party Liability ( TPL ) coverage and access information for nursing home and hospital insurance policies. All members must:
Sign over to the State of Wisconsin all their rights to payments from hospital or nursing home insurance (See 9.2.2 Assignment). Members enrolled in a Managed Long Term Care program must assign payments to the Managed Care Organization (MCO).
Turn over any payments to the State of Wisconsin (See 9.2.3 Recovery of Payments) that he or she received from nursing home or hospital insurance while receiving Medicaid. Members enrolled in a Managed Long Term Care program must turn over payments to the Managed Care Organization (MCO).
Any nursing home or hospital insurance payments that exceed the amount that Medicaid has paid in benefits for that member will be refunded to him/her.
Terminate Medicaid eligibility for the individual who is not cooperating in providing TPL insurance information (See 9.1.2 TPL Cooperation), unless they have good cause (See 9.1.4 TPL Good Cause Claim).
To assign hospital or nursing home insurance payments, the member must provide a statement in writing to the insurance company requesting that all future payments be made to the State of Wisconsin. Request a copy of the member’s letter to the insurance company and send it to the following address:
ForwardHealth
TPL Unit
313 Blettner Blvd
Madison WI
53714-2405
The assignment includes all ongoing payments for as long as Medicaid is received. Terminate Medicaid eligibility for the individual who refuses to sign over these payments.
In some cases, payments can only be signed over to the patient. The member must cooperate in turning over these payments to the State of Wisconsin, or his/her eligibility will end for not cooperating with providing TPL coverage and access information.
The member must write on the back of the check “Pay to the order of the State of Wisconsin” and sign the check.
Collect the payments monthly from the members along with the corresponding Explanation of Benefits ( EOB ), and send them to the following address:
State of Wisconsin
Department of Health Services
IBB Department
P.O. Box 6220
Madison, Wisconsin 53784
Close the case for non-cooperation with TPL requirements if the member refuses to turn over the payments.
This page last updated in Release Number: 15-01
Release Date: 06/10/2015
Effective Date: 06/10/2015
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030