Benefit Coordination & Recovery
(614) 752-5768
The Benefit Coordination & Recovery Section is responsible for:
Third Party Liability (TPL) & Recoveries: Third party liability refers to the legal obligation of certain health care sources (third party sources) to pay for all, or part of, the medical claims of Medicaid beneficiaries before Medicaid pays these claims. The Medicaid program, by law, is intended to be the payer of last resort; that is, all other available third party resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of an eligible individual. Recovery of Medicaid payments are made when other commercial or public health insurance carriers should have paid for the service.
Cost Avoidance: Preventing Medicaid payment when other health insurance coverage exists. Medicaid providers may use the JFS 06614, Health Insurance Fact Form, to inform the Cost Avoidance Unit of changes in third party insurance coverage. Forms may be faxed to: 614-728-0757
Pay and Chase: Recovering from liable third parties for medical expenses paid by Medicaid
Payment Coordination: Processing a claim when Medicaid is the secondary payer
Medicare Buy-In: The Buy-In unit processes Medicare Buy-In eligibility requests that are not updated through the county department of job and family services eligibility system and ensures payment for Medicare premiums for certain groups of consumers. This area is also responsible for updating, correcting and backdating Medicaid eligibility spans in the state's claims payment system, known as the medicaid management information system (MMIS). This is done when the county identifies an eligibility interface issue and then sends a JFS 07102 for the state to update MMIS. Providers should work with the county department of job and family services when they feel there is an eligibility issue in MMIS.
Ohio's Cost Avoidance Efforts & Contractor