Cov Neeg Ua Haujlwm Cov Nyiaj Pov Hwm Rov Qab Los
Txog Peb
Lub Department of Health Care Services '(DHCS) Workers 'Compensation Recovery Program nrhiav kev them nyiaj rov qab rau cov kev pab cuam uas Medi-Cal them rau sawv cev ntawm nws cov neeg tau txais txiaj ntsig uas muaj cov neeg ua haujlwm cov nyiaj them rov qab nrog rau cov tswv ntiav, tuam txhab pov hwm, lossis Pawg Neeg Ua Haujlwm Pabcuam Kev Ua Haujlwm (WCAB. ). Thaum tus neeg tau txais txiaj ntsig Medi-Cal tau txais kev txiav txim siab, 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, Txoj Haujlwm Pabcuam Cov Neeg Ua Haujlwm Pabcuam Rov Qab (Workers' Compensation Recovery Program) yuav tsum tau los ntawm tsoomfwv thiab Xeev txoj cai lij choj kom rov qab tau nyiaj rau cov kev pabcuam cuam tshuam los ntawm Medi-Cal. .
Rau cov ntaub ntawv hais txog kev raug mob ntawm tus kheej, kev kho mob tsis zoo, lossis kev hais plaub hauv chav kawm, siv cov kev txuas hauv qab no mus rau chav kho kom rov zoo.
Lien txheej txheem
Tus neeg tau txais txiaj ntsig Medi-Cal lossis tus neeg sawv cev ntawm tus kheej yuav tsum tau hais los ntawm txoj cai lij choj kom tshaj tawm qhov kev txiav txim lossis thov sau ntawv mus rau DHCS raws li Welfare and Institutions (W&I) Code Section 14124.70 thiab seq. DHCS kuj tau txais cov ntaub ntawv hais txog cov neeg ua haujlwm cov nyiaj them rov qab los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Lag Luam Kev Lag Luam txhawm rau txheeb xyuas cov neeg tau txais txiaj ntsig Medi-Cal thiab lawv cov lus thov. Yog tias tus neeg ua haujlwm raug mob yog Medi-Cal tsim nyog, DHCS xaj thiab tshuaj xyuas cov ntaub ntawv them nyiaj. Cov kws kho mob muaj txog li ib xyoos txij li hnub tau txais kev pab xa cov nqi mus rau Medi-Cal rau kev them nyiaj. DHCS yuav lees paub tias txhua qhov kev pabcuam raug mob raug txheeb xyuas thiab xa daim ntawv tsis txaus siab rau cov tog neeg tsim nyog.
Thov mus saib lub Department of Industrial Relations lub vev xaib kom paub ntau ntxiv txog cov neeg ua haujlwm cov nyiaj them poob haujlwm. (Tsis yog DHCS)
Yog tias cov nyiaj yuav raug muab tso rau hauv Special Needs Trust, thov mus rau ntawm Special Needs Trust lub website rau cov lus qhia ntxiv txog kev ceeb toom rau DHCS 'Special Needs Trust Unit.
DHCS Lien Process: Workers’ Compensation
- Kev raug mob/kev mob raug qhia rau DHCS.
Kev ceeb toom yog muab los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Lag Luam Kev Lag Luam (DIR) lossis ntawm Daim Ntawv Online. - DHCS kuaj xyuas seb tus neeg ua haujlwm raug mob puas yog Medi-Cal tus tswv cuab.
If the Injured worker is not a Medi-Cal member, DHCS will not create a workers’ compensation case. If the injured worker is a Medi-Cal member, a workers’ compensation case is created. - DHCS yuav xaj cov ntaub ntawv them nyiaj 120 hnub txij li hnub them nyiaj lossis hnub kawg ntawm kev kho mob, seb qhov twg tshwm sim ua ntej.
Raws li Tshooj Cai Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv 14115, cov chaw 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. DHCS thov cov ntaub ntawv them nqi (suav nrog, tab sis tsis txwv rau, Medi-Cal cov kev pabcuam them nqi thiab cov tshuaj uas cuam tshuam nrog kev raug mob) tsis pub dhau 120 hnub tom qab hnub them nyiaj lossis hnub kawg ntawm kev kho mob, kom muaj sijhawm txaus rau cov kws kho mob them nqi rau Medi-Cal. - DHCS may order payment data from Managed Care Plan (MCP).
Payment 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). - Once DHCS receives payment data, a DHCS representative will review and create a lien, if applicable. Per Welfare and Institutions Code section 14124.71, DHCS is authorized to recover the reasonable value of benefits provided on behalf of the beneficiary.
- DHCS yuav ua ntaub ntawv thov kev pab nrog Electronic Adjudication Management System (EAMS) thiab ua hauj lwm rau cov tog neeg xav tau.
Them Lien
Txhawm rau thov kev them nyiaj rau tus as-qhauj kom raug, DHCS tus lej account yuav tsum suav nrog txhua qhov kev xa nyiaj. Rau koj txoj kev yooj yim, cov kev xaiv them nyiaj hauv qab no muaj:
1. Kev Them Nyiaj los ntawm Kev Hloov Nyiaj Hluav Taws Xob (EFT) - Txhawm rau pib mus rau EFT lub vev xaib . Ob qhov kev xaiv EFT tshwj xeeb muaj nyob rau kom haum rau koj cov kev xav tau:
Kev Them Nyiaj Ib Zaug Xwb - Zoo tagnrho rau cov neeg tau txais txiaj ntsig Medi-Cal thiab cov chaw uas muaj ob peb qhov kev thov nyiaj pab.
Kev Them Nyiaj Rau Tus Neeg Siv Uas Tau Sau Npe - Zoo tagnrho rau cov chaw uas tswj hwm ntau rooj plaub thiab them ntau zaus. Qhov kev xaiv no tso cai rau tus neeg siv teem sijhawm them nyiaj yav tom ntej thiab taug qab keeb kwm them nyiaj. Yuav kom los ua ib tug neeg siv uas tau sau npe lawm, ua kom tiav cov hauv qab no:
Kauj Ruam 1: Xa Daim Ntawv Thov Sau Npe Tshiab. Tso cai rau tsib (5) hnub ua haujlwm rau DHCS los lees paub cov ntaub ntawv thiab tsim koj tus account Enrolled User.
Kauj Ruam 2: Sau npe ua Tus Neeg Siv uas tau sau npe. Ua raws li cov lus qhia uas DHCS muab thaum tau txais koj daim ntawv lees paub rau npe.
Txhawm rau kom paub meej ntxiv txog kev xa EFT them nyiaj, saib EFT Cov Lus Qhia Qhia.
2. Kev them nyiaj los ntawm daim tshev - Xa rau:
Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit – MS 4720
PO ib 997421
Sacramento, CA 95899-7421
Thov siv DHCS tus lej account ntawm daim tshev thiab tso cai 15 mus rau 30 hnub ua haujlwm rau DHCS tau txais thiab siv cov nyiaj them poob haujlwm.
If an insurance company issues a single check with both you and DHCS listed, please review visit the Frequently Asked Questions. Instructions are provided in Question 11 under the FAQs for Beneficiaries/Attorneys heading.
Cov ntaub ntawv tiv tauj
Cov ntawv online
Notify and update DHCS electronically using the Online Forms webpage.
Xa daim ntawv ceeb toom thov tshiab lossis cov ntaub ntawv ntawm qhov kev thov uas twb muaj lawm
Thov Nco Ntsoov: Cov lus teb tsuas yog yuav muab yog tias DHCS lees paub Medi-Cal lien.
Xov tooj Support Unit
The Phone Support Unit provides information to Medi-Cal Beneficiaries pursuing a workers’ compensation claim.
Please visit the Phone Support Unit – Online Inquiries webpage for more information.
Tiv tauj peb
Koj tuaj yeem tiv tauj peb hauv xov tooj, email, thiab xa ntawv.
Xov Tooj: (916) 445-9891
Sij Hawm Ua Haujlwm: Hnub Monday txog Hnub Friday – 8:00 sawv ntxov txog 5:00 tsaus ntuj, kaw txij 12:00 tav su txog 1:00 tav su
Kaw rau hnub so thiab hnub caiv ntawm lub xeev
Email: WC@dhcs.ca.gov
Chaw nyob xa ntawv rau kev sib tham sau ntawv:
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv
Lub Chaw Haujlwm Saib Xyuas Kev Them Nqi thiab Kev Rov Qab Tau Nyiaj Rau Sab Nraud
Chav Haujlwm Saib Xyuas Kev Them Nyiaj Rau Cov Neeg Ua Haujlwm - MS 4720
PO Thawv 997425
Sacramento, CA 95899-7425