工伤赔偿恢复计划
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Department of Health Care Services (DHCS)工伤赔偿追偿Program旨在为Medi-Cal代表其受益人支付的服务寻求补偿，这些受益人向雇主、保险公司或工伤赔偿上诉委员会 (WCAB) 提出了工伤赔偿索赔。 当Medi-Cal受益人从负有责任的第三方获得和解金、判决或裁决作为对其所受伤害的补偿时，联邦和州法律要求工人赔偿追偿Program收回Medi-Cal支付的任何相关服务的资金。
对于涉及人身伤害、医疗事故或集体诉讼的索赔，请使用下面的链接联系相应的恢复部门。
留置权程序
The Medi-Cal beneficiary or personal representative is required by law to report an action or claim in writing to DHCS pursuant to Welfare and Institutions (W&I) Code Section 14124.70 et seq. DHCS also receives workers’ compensation claims information from the Department of Industrial Relations in order to identify Medi-Cal beneficiaries and their claims. If the injured worker is Medi-Cal eligible, DHCS orders and reviews the payment records. Medical providers have up to one year from the date of service to submit bills to Medi-Cal for payment. DHCS will confirm all injury-related services have been identified and submit a lien to the appropriate parties.
请访问工业关系部网站以获取有关工人赔偿索赔的更多信息。 （非 DHCS）
If funds will be placed into a Special Needs Trust, please go to the Special Needs Trust website for further instructions on notifying DHCS’ Special Needs Trust Unit.
DHCS留置权流程：工伤赔偿
- 伤害/疾病已报告给 DHCS。
通知由工业关系部（DIR）或通过在线表格提供。 - DHCS 检查以确定受伤工人是否是 Medi-Cal 会员。
如果受伤工人不是 Medi-Cal 会员，DHCS 将不会创建工伤赔偿案件。如果受伤工人是 Medi-Cal 会员，则会启动工伤赔偿程序。 - DHCS 将在结算日期或最终治疗日期（以先发生者为准）起 120 天后订购付款数据。
根据《福利和机构法》第 14115 条规定，医疗服务提供者自服务之日起有一年的时间向 Medi-Cal 开具账单。医疗服务提供者通常会在服务日期后的四个月内向 Medi-Cal 提交账单。DHCS 要求提供付款数据（包括但不限于与伤情相关的 Medi-Cal 支付的服务和药物），最早也要在和解日期或最终治疗日期后 120 天，以便医疗服务提供者有足够的时间向 Medi-Cal 开具账单。 - DHCS 可要求管理性医疗计划 (MCP) 提供付款数据。
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 将向电子裁决管理系统 (EAMS) 提交适用的留置权并送达所需当事人。
支付留置权
为了将付款应用到正确的账户，每次付款提交时都必须包含 DHCS 帐号。 为了您的方便，您可以选择以下付款方式：
1. 通过电子资金转账（EFT）付款——开始请访问EFT 网站。 有两种独特的 EFT 选项可满足您的需求：
One-Time Payment – Ideal for Medi-Cal beneficiaries and entities with few claims.
Enrolled User Payment – Ideal for entities that manage numerous cases and make multiple payments. This option allows the user to schedule future payments and track payment history. To become an enrolled user, complete the following:
Step 1: Submit a New Enrollment Request. Allow five (5) business days for DHCS to confirm the information and create your Enrolled User account.
Step 2: Register as an Enrolled User. Follow the instructions provided by DHCS upon receiving your confirmation of enrollment.
有关提交 EFT 付款的进一步说明，请参阅EFT 信息指南。
2. 支票付款 – 提交至：
医疗服务部
第三方责任与追偿处
工人赔偿股 - MS 4720
P.O.信箱 997421
加利福尼亚州萨克拉门托 95899-7421
请在支票上注明 DHCS 帐号，DHCS 需要 15 到 30 个工作日才能收到并应用付款。
如果保险公司开具的支票上同时列出了您和DHCS，请查看常见问题解答。说明请参见“受益人/律师常见问题解答”标题下的问题 11。
联系信息
在线表格
Notify and update DHCS electronically using the Online Forms webpage.
提交新的索赔通知或现有索赔的信息
请注意：仅当 DHCS 主张 Medi-Cal 留置权时才会提供答复。
电话支持部门
电话支持部门为正在申请工伤赔偿的 Medi-Cal 受益人提供信息。
请访问电话支持部门 - 在线咨询网页了解更多信息。
联系我们
您可以通过电话、电子邮件和邮件联系我们。
Phone: (916) 445-9891
Hours of operation: Monday through Friday – 8:00 a.m. to 5:00 p.m., closed from 12:00 p.m. to 1:00 p.m.
Closed on weekends and State Holidays
Email: WC@dhcs.ca.gov
Mailing address for written correspondence:
Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit – MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425