Reporting Subrogation
In connection with its contracts with the State of North Carolina; the Social Security Act; 42 C.F.R. § 433 Subpart D; and N.C. Gen. Stat. § 108A-57 et al. Partners is obligated to identify and collect third-party liability for claims, including subrogation.
Partners must pursue subrogation when a Medicaid beneficiary receives medical treatment and/or related services and equipment due to an injury caused by the action, inaction or negligence of a third-party. Such injuries may include, but are not limited to:
- Automobile accidents
- Sports injuries
- Job injuries
- Injury caused by defective product
- Medical malpractice
- Neglect or abuse
In these situations, the actions of a third party may create a cause of action for the injured Medicaid beneficiary, who may make a claim for damages to cover medical treatment and other losses incurred due to the injury. The action taken based on an injury claim may be settled in or out of court.
Medicaid programs that have paid for medical treatment, equipment or services have an interest in these cases based on the Medicaid beneficiary’s assignment of his/her rights to third-party payments to the Medicaid program as a condition of eligibility, in accordance with section 1912(a)(1)(A) of the Social Security Act.
This assignment gives the Medicaid program a right of subrogation, allowing the program to “stand in the shoes” of the Medicaid beneficiary, who has made a claim against a liable third party. Medicaid may recover from settlements but only from compensation designated for paying medical expenses.
If you have a client and/or case that may be subject to subrogation, please contact Partners’ subrogation team at PartnersSubrogation@PartnersBHM.org.
To help us determine if you or your client has claims that might be subject to subrogation, we will need the follow information along with an Authorization for Use, Disclosure and Exchange of Protected Health Information form:
- Medicaid Member’s Name
- Member’s Medicaid ID number
- Payor (e.g., Partners Health Management)
- Type of Injury
- Date of Injury