Medical Malpractice Recovery Program
Txog Peb
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv '(DHCS) Kev Pabcuam Kev Khomob Khomob Khomob nrhiav kev them nyiaj rov qab rau cov kev pabcuam uas Medi-Cal them rau sawv cev ntawm nws cov tswvcuab uas koom nrog lwm tus neeg ua, xws li kev kho mob thiab kev kho hniav, kev raug mob thaum yug, 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, kev txiav txim lossis khoom plig los ntawm tus neeg thib peb lub luag haujlwm raws li kev them nyiaj rau kev raug mob uas lawv tau tshwm sim, Qhov Kev Pabcuam Khomob Khomob tsis zoo yuav tsum tau los ntawm tsoomfwv thiab Lub Xeev txoj cai kom rov qab tau nyiaj rau cov kev pabcuam cuam tshuam uas tau them los ntawm Medi-Cal.
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 raug cai lij choj yuav tsum tshaj tawm ib qho kev nqis tes ua lossis kev thov ua ntawv sau 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):
(1) Hnub tim Medi-Cal tus tswv cuab raug mob,
(2) Medi-Cal tus tswv cuab tus lej Medi-Cal,
(3) cov ntaub ntawv tiv tauj ntawm lub luag haujlwm thib peb lossis tus neeg tuav pov hwm,
(4) cov ntaub ntawv tiv tauj ntawm tus thawj tswj hwm kev thov suav nrog lawv tus lej thov, thiab
(5) cov ntaub ntawv tiv tauj ntawm ib tus kws lij choj tiv thaiv uas sawv cev rau tus neeg thib peb lub luag haujlwm lossis tus tuav pov hwm.
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
Per Welfare and Institutions Code 14124.73, the injured party is required to notify DHCS within 30 days of filing a claim or action. The notification must include the date of injury, Medi-Cal member’s identification number, and the name and contact information for the liable third party. The notification should be reported via Online Forms. - 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
Per Welfare and Institutions Code section 14115, providers have up to one year from the date of service to bill Medi-Cal. Providers typically bill Medi-Cal within four months of the date of service. By waiting 120 days after the FDOT or SD, DHCS is allowing providers a reasonable time to bill Medi-Cal. - DHCS xaj cov ntaub ntawv them nyiaj los ntawm Managed Care Plan (MCP)
Data may be ordered from multiple MCPs if the member is enrolled in multiple plans during the treatment period. DHCS does not store MCP payment data in-house and does not control the MCPs’ response time. Typically a MCP will respond to DHCS’ request for records within 120 days, but additional time may be needed. Records may need to be ordered from multiple Independent Physician Associations (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 muab tso rau hauv Special Needs Trust, thov mus rau lub vev xaib Special Needs Trust rau cov lus qhia ntxiv txog kev ceeb toom DHCS 'Special Needs Trust Unit.