Personal Injury Unit
The goal of the Personal Injury Unit (PIU) is to identify funds Medi-Cal paid on behalf of beneficiaries in personal injury actions such as: auto liability, premises liability, product liability and other tort liability actions.
We are notified of a potential third party liability case from a variety of sources.
- Medi-Cal beneficiaries
- Attorneys & Insurance carriers Medical providers,
- Managed Care Plans (MCP) and other state and county agencies.
The Medi-Cal beneficiary or personal representative is required by law to report in writing to the Department of Health Care Services (DHCS) pursuant to Welfare and Institutions Code Section 14124.70 et seq. (W&I Code). These referrals must be submitted online or by mail within 30 days of filing an action or claim. Attorneys must submit a Medical Authorization from their client.
If the injured party is Medi-Cal eligible, DHCS will send a Notice of Lien stating our rights to recovery. Receiving a Medi-Cal lien amount can take up to 120 days. If the claimant is not currently Medi-Cal eligible DHCS may send a notice stating that their Medi-Cal status will be rechecked in 90 days for retroactive eligibility.
After DHCS reviews payment data, an itemized list of injury-related services will be established, and a lien will be sent to the Medi-Cal beneficiary or personal representative and the liable third party.
Medical providers have up to one year from date of service to submit bills to Medi-Cal for payment. Once all related services have been identified, the final lien will be established when the beneficiary has reached a settlement. DHCS has the right to collect for dates of services provided up to the date of settlement.
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Last modified on:
11/10/2016 1:46 PM