Other Liable Parties

Under the provisions of HMSA plans, medical claims for which a third party may be responsible are not payable. These provisions apply to claims for services provided in connection with an illness or injury for which a third party, including Workers' Compensation and motor vehicle insurance, is responsible. Claims for such services must be submitted to the responsible party's insurance carrier.

Admission Notice

Submission of admission notices and census reports, along with accident information and admitting diagnosis, helps HMSA predetermine if a third party liability, motor vehicle or Workers' Compensation claim is applicable. Submitting admission notices and census reports in a timely manner also helps prevent erroneous payments and future recovery requests. Refer to Admission Notice, Census Report for more information.

Reimbursement

If HMSA pays benefits for services that should have been billed to a third party liability, motor vehicle or Workers' Compensation insurance carrier, HMSA will seek reimbursement from the participating provider.

Timely Filing

Once a claim has been filed to the responsible third party, it is important to monitor the claim. All claims, including other party liability, are subject to HMSA's one-year timely filing limitation.

Revision History