Library: Policy

340:75-13-78. Third party liability, accident, or injury

Revised 6-1-07

     When medical services are provided to a recipient of Medicaid as the result of an accident or injury, the Child Welfare (CW) worker determines if there has been or may be monetary settlements that affect eligibility.  The Oklahoma Health Care Authority (OHCA), Third Party Liability Unit checks all paid claims for potential accident or trauma related diagnosis codes and follows up on those directly with the recipient. 

• (1) If the recipient fails to cooperate or does not respond to requests from OHCA, OHCA may request the local office to submit Form 08AD050E, Third Party Liability Resource. 

• (2) If a recipient continues to not respond to requests for information or fails to cooperate with the CW worker, the worker suspends further benefits until the recipient has supplied the necessary information to OHCA.