Coordination of Benefits

Summarized by Plex Health
Last Updated: 10 May 2022

It is feasible for Medicaid beneficiaries to have one or more extra sources of coverage for healthcare solutions. 3rd party Liability describes the lawful commitment of 3rd events to pay part or every one of the expenditures for clinical aid furnished under a Medicaid state plan. By regulation, all other available 3rd party resources need to meet their lawful commitment to pay insurance claims prior to the Medicaid program pays for the care of an individual eligible for Medicaid. States are required to take all sensible steps to identify the legal liability of 3rd parties to pay for treatment and solutions that are readily available under the Medicaid state plan. Coordination of Benefits refers to the tasks entailed in identifying Medicaid benefits when an enrollee has insurance coverage through a private, entity, insurance policy, or program that is responsible to spend for healthcare solutions. Individuals qualified for Medicaid designate their rights to 3rd party repayments to the State Medicaid Agency.

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