R6-6-1303. Collections of Health Insurance

A. Service providers shall identify and pursue collections of reimbursement from all probable sources of third-party liability. B. Service providers shall identify and notify the Division of any and all changes in health insurance information for clients. C. The Division is the payor of last resort for DD/non-ALTCS Division-covered services, unless specifically prohibited by law. Service providers shall submit all claims covered by health insurance to the insurer prior to submitting a claim for payment to the Division. D. When submitting a claim for payment to the Division, service providers shall include a copy of the explanation of benefits from the health insurer. The Division shall not pay for covered services if the client has insurance coverage which will pay for the service. E. If a responsible person receives an insurance or benefit payment for a service provided through the Division, the amount received as payment is immediately due and payable to the Division. If the amount is not paid, the Division shall terminate eligibility.