State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

5.6 Casualty Claim Process (Subrogation)

5.6.1 Reporting Accident or Injury Claims

 

 

 

Casualty claims are those claims for BadgerCare Plus benefits resulting from an accident or injury for which a third party may be liable.

 

 

Example 1: Mike receives treatment for injuries suffered when he was hit by a car. The vehicle owner is the third party and may be responsible for reimbursing BadgerCare Plus for those benefits. If Mike is working with an attorney or insurance agency to settle the claim, he is legally obligated to give notification to the local agency .

  BadgerCare Plus members should report any casualty claims before the case is settled. The BadgerCare Plus ID number of the BadgerCare Plus member, date of the accident, and the insurance company or name of the attorney to bill should be included with the referral.

5.6.1 Reporting Accident or Injury Claims

Members must report any cash award or settlement due to an accident or injury if BadgerCare Plus paid for part or all of the care received as a result of the accident or injury. Members must also report if they have hired an attorney or is working with an insurance agency to settle an accident or injury claim.

1. If a member reports a claim and is receiving SSI or, on the date of the accident or  injury was receiving Wisconsin Medicaid or BadgerCare Plus, he or she must report the accident or injury case to the Casualty Recovery Unit at:

 

WI Casualty Recovery—HMS

5615 Highpoint Dr., Suite 100

Irving, TX 75038-9984

 

Telephone:  (877) 391-7471

Fax:  (469) 359-4319

Email:   wicasualty@hms.com

Website:  www.wicasualty.com/wi/index.htm

 

Note: If the member is enrolled in an HMO or MCO they must also report the accident or injury to that organization.

 

2. All other Medicaid members should report in person or via phone their local agency and any HMO or MCO that may have provided services, before the case is settled. Members should include the date of the accident and any insurance/attorney information.   

     

This page last updated in Release Number: 16-01

Release Date: 02/15/2016

Effective Date : 02/15/2016

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The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171