Medical Malpractice Recovery Program
Txog Peb
Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) Txoj Haujlwm Kho Mob Tsis Zoo nrhiav kev them rov qab rau cov kev pabcuam uas Medi-Cal tau them rau nws cov tswv cuab uas koom nrog kev ua txhaum cai ntawm lwm tus, xws li kev kho mob tsis zoo thiab kev kho hniav, kev raug mob thaum yug los, kev tsim txom cov neeg laus thiab kev tuag tsis raug cai. Thaum ib tug tswv cuab ntawm Medi-Cal tau txais kev sib hais haum, kev txiav txim lossis khoom plig los ntawm ib tus neeg thib peb uas muaj lub luag haujlwm ua kev them nyiaj rau kev raug mob uas lawv tau ua, Txoj Cai Lij Choj thiab Lub Xeev yuav tsum tau ua kom Medical Malpractice Recovery Program rov qab tau nyiaj rau txhua yam kev pabcuam cuam tshuam uas Medi-Cal them.
Rau cov ntaub ntawv hais txog kev raug mob ntawm tus kheej, kev hais plaub hauv chav kawm, lossis cov nyiaj them rau cov neeg ua haujlwm, siv cov kev sib txuas hauv qab no mus rau chav kho kom rov zoo.
Lien txheej txheem
Tus tswv cuab Medi-Cal lossis tus neeg sawv cev tus kheej raug cai lij choj yuav tsum tshaj tawm ib qho kev nqis tes ua lossis kev thov ua ntawv rau DHCS raws li Welfare and Institutions (W&I) Code Seem 14124.70 et seq. Cov ntawv ceeb toom yuav tsum xa mus rau nplooj ntawv ceeb toom rooj plaub hauv online lossis xa ntawv tsis pub dhau 30 hnub tom qab ua ntaub ntawv foob lossis thov, thiab YUAV TSUM suav nrog cov hauv qab no raws li W&I Code Section14124.73(c):
- The date of the Medi-Cal member’s injury,
- the Medi-Cal member’s Medi-Cal identification number,
- the contact information of the liable third party or insurer,
- the contact information of the claims administrator including their claim number, and
- the contact information of any defense counsel representing the liable third party or insurer.
Thov cia 30 hnub rau DHCS xa ib tsab ntawv lees paub tias tau txais daim ntawv ceeb toom.
DHCS Lien Txheej txheem cej luam: Kev kho mob tsis zoo
- Kev raug mob raug qhia rau DHCS
Raws li Txoj Cai Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv 14124.73, tus neeg raug mob yuav tsum ceeb toom rau DHCS hauv 30 hnub tom qab ua daim ntawv thov lossis kev nqis tes ua. Daim ntawv ceeb toom yuav tsum muaj hnub raug mob, tus lej cim tus tswv cuab Medi-Cal, thiab lub npe thiab cov ntaub ntawv tiv tauj rau tus neeg thib peb uas muaj lub luag haujlwm. Daim ntawv ceeb toom yuav tsum tau tshaj tawm los ntawm Daim Ntawv Online. - DHCS kuaj xyuas seb tus neeg raug mob puas yog Medi-Cal tus tswv cuab
Yog tias tus neeg raug mob tsis yog Medi-Cal tus tswv cuab, DHCS yuav ceeb toom rau pawg neeg xa khoom. - Yog tias tus neeg raug mob yog ib tug tswv cuab ntawm Medi-Cal, qhov teeb meem kho mob tsis zoo yog tsim
A DHCS representative will contact the attorney, insurance, or member to request documentation regarding the injury event. Per Welfare and Institutions Code 14124.71, DHCS has the right to assert a lien against any settlement, judgment, or award obtained from a liable third party. - Hnub Kawg Kev Kho Mob (FDOT) lossis Hnub Txiav Txim (SD) muaj?
A FDOT and/or SD allows DHCS to determine the services attributable to the liable third party. Without a FDOT or SD, DHCS is unable perfect its lien under Welfare and Institutions Code 14124.76. If a FDOT or SD is available, you may complete the Preliminary or final lien Request Form (see below for more details). - Ua ntej xaj cov ntaub ntawv them nqi DHCS yuav tso cai tsawg kawg 120 hnub kom dhau los ntawm FDOT lossis SD
Raws li Tshooj Cai Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv 14115, cov neeg muab kev pabcuam muaj sijhawm txog ib xyoos txij li hnub muab kev pabcuam los them nqi rau Medi-Cal. Feem ntau cov kws kho mob yuav xa daim nqi rau Medi-Cal tsis pub dhau plaub lub hlis txij li hnub uas tau txais kev pab. Thaum tos 120 hnub tom qab FDOT lossis SD, DHCS tso cai rau cov neeg muab kev pabcuam kom muaj sijhawm tsim nyog los them nqi rau Medi-Cal. - DHCS xaj cov ntaub ntawv them nyiaj los ntawm Managed Care Plan (MCP)
Cov ntaub ntawv yuav raug xaj los ntawm ntau lub MCPs yog tias tus tswv cuab tau sau npe rau ntau txoj kev npaj thaum lub sijhawm kho mob. DHCS tsis khaws cov ntaub ntawv them nqi ntawm MCP rau hauv tsev thiab tsis tswj lub sijhawm teb ntawm MCP. Feem ntau MCP yuav teb rau DHCS qhov kev thov rau cov ntaub ntawv hauv 120 hnub, tab sis tej zaum yuav xav tau sijhawm ntxiv. Cov ntaub ntawv yuav tsum tau xaj los ntawm ntau lub Koom Haum Kws Kho Mob Ywj Pheej (IPAs). - Thaum cov ntaub ntawv them nyiaj tuaj txog, DHCS yuav tshuaj xyuas thiab tsim daim ntawv lav, yog tias muaj
Raws li Kev Noj Qab Haus Huv thiab Tsev Kawm Ntawv Code 14124.71, DHCS tau tso cai kom rov qab tau tus nqi tsim nyog ntawm cov txiaj ntsig tau muab rau sawv cev ntawm tus tswv cuab. - DHCS will send a “lien” or “no lien” letter to the appropriate parties
Per Welfare thiab Institutions Code 14124.75, DHCS khaws cov cai them rov qab rau tus nqi tsim nyog ntawm cov txiaj ntsig tau muab kom txog thaum tag nrho cov kev daws teeb meem cuam tshuam txog qhov kev thov thawj zaug lossis kev nqis tes ua tiav.
Thov Kev Pab Ua Ntej lossis Kawg Lien
Ib rooj plaub yuav tsum raug tsim los ntawm Lub Tsev Haujlwm ua ntej yuav xa daim ntawv thov nyiaj, thiab tag nrho cov kev thov qiv nyiaj ua ntej thiab zaum kawg yuav tsum xa hauv online. Txhawm rau thov qhov kev lees paub ua ntej lossis zaum kawg los ntawm Lub Tsev Kho Mob Tsis Txaus Siab ntawm qhov teeb meem tsim, nyem rau ntawm qhov txuas hauv qab no. Thaum ua tiav daim ntawv thov, koj yuav tsum muab cov ntaub ntawv tseem ceeb ntsig txog koj qhov kev thov thiab cov ntaub ntawv txhawb nqa raws li qhov xav tau.
Daim Ntawv Thov Kev Them Nqi Ua Ntej lossis Zaum Kawg
Thov nco ntsoov: Chav Kho Mob Tsis Zoo tsis lees txais cov lus thov ua ntej lossis zaum kawg ntawm TMU@dhcs.ca.gov lawm.
Thaum tus tswv cuab tau kho tiav lossis muaj kev sib hais haum, DHCS yuav xaj thiab tshuaj xyuas cov ntaub ntawv them nqi kom tsim tau "lien," lossis daim ntawv teev cov kev pabcuam cuam tshuam nrog kev raug mob uas yuav tsum tau sau. Siv Cov Ntawv Online los qhia rau DHCS thaum twg kev kho mob xaus lossis kev sib hais haum tau tshwm sim lossis siv Daim Ntawv Thov Kev Tiv Thaiv Ua Ntej lossis Daim Ntawv Thov Kev Tiv Thaiv Zaum Kawg los thov kev tiv thaiv. DHCS muaj cai rov qab tau txog hnub uas tau daws teeb meem lossis daws teeb meem tag nrho ntawm txhua qhov kev foob uas cuam tshuam nrog kev raug mob, raws li W&I Code Seem 14127.785. Thaum txhua qhov kev sib hais haum, tus tswv cuab lossis tus neeg sawv cev yuav tsum ceeb toom rau DHCS kom npaj tau qhov kev hloov kho tshiab raws li W&I Code Seem 14124.76 thiab 14124.79. Yog xav paub ntxiv txog cov txheej txheem lien thiab lub sijhawm, mus saib peb Cov Lus Nug Nquag Nug.
Yog tias cov nyiaj yuav raug muab tso rau hauv Lub Koom Haum Saib Xyuas Kev Xav Tau Tshwj Xeeb, thov mus rau nplooj ntawv web ntawm Lub Koom Haum Saib Xyuas Kev Xav Tau Tshwj Xeeb kom tau cov lus qhia ntxiv txog kev ceeb toom rau DHCS' Lub Koom Haum Saib Xyuas Kev Xav Tau Tshwj Xeeb.