§ 50769. Department Responsibility -Other Health Care Coverage.

(a) On the Medi-Cal card of beneficiaries who have other health care coverage, the Department shall place an indicator code to give notice to providers and beneficiaries that other health care coverage must be utilized prior to billing the Medi-Cal program.

(b) The Department's fiscal intermediary shall, as directed by the Department, deny provider claims submitted for beneficiaries who have other health care coverage unless the claim is accomplished by a notice of denial of non-coverage of service, termination of coverage, or partial payment which is less than the Medi-Cal schedule of benefits for the service or benefit provided. A provider of service may submit a copy of the original notice of denial or explanation of benefits letter from the other health care coverage. This notice or letter is valid for a period of one year from the date the service was denied. The notice or letter must be accompanied by a completed Medi-Cal claim form for the same service provided to the beneficiary as indicated on the notice or letter.

(c) When Medi-Cal payment has been made before the other health care coverage has been identified, the Department shall recover payments from the parties having a legal obligation.

HISTORY

1. Repealer and new section filed 6-28-89; operative 7-28-89 (Register 89, No. 28).

Note

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code, Reference: Sections 14023, 14023.7, 14124.90. Welfare and Institutions Code.