Library: Policy

340:75-13-77. Potential payment from third party sources

Revised 6-1-07

     Section 447.20 of Title 42 of the Code of Federal Regulations requires that the Oklahoma Department of Human Services take all reasonable measures to ascertain liability of a third party, for example, private insurance, to pay for care and services. 

• (1) Third party liability is treated as a resource if payment by a third party has been made on behalf of the recipient. 

• (A) In instances where such liability is found to exist after medical assistance has been made available, the Oklahoma Health Care Authority (OHCA) seeks reimbursement to the extent of such legal liability. 

• (B) If the applicant or recipient has already received payments from a third party, Form 08AD050E, Third Party Liability Resource, is completed and submitted to the OHCA Third Party Liability Unit. 

• (2) The Child Welfare worker is responsible for identifying and providing all insurance information for each child.  Private insurance information is provided to the custody specialist and the custody specialist is kept current on any changes in the private insurance.  OHCA accesses private insurance for payment of medical claims before Medicaid pays on the claims.