The Casualty Recovery Team works to coordinate benefit and collection practices with providers, members, and other insurance companies to ensure that Medicaid is the payer of last resort. The team is responsible for Medicare Part D casework including claims processing assistance, coverage verification, and issue resolution.

The Provider Team monitors the adequacy of the Green Mountain Care (GMC) network of providers and ensures that members are served in accordance with managed care requirements. 

The Third Party Liability Team (TPL) works diligently to recover funds from third parties where Medicaid should not have been solely responsible. Those efforts include estate recovery, absent parent medical support recovery, casualty recovery, patient liability recovery, Medicare recovery, Medicare prescription recovery, special needs recovery, and trust recovery. The team has been able to increase TPL cost avoidance dollars, a direct result of ensuring that correct TPL insurance information is in the payment systems and being used appropriately.

The Transportation Team ensures members have access to appropriate healthcare for their medical, dental, and mental health needs.  The Green Mountain Care Member Support Center contractor is the point of initial contact for members’ questions and concerns.  The team oversees the Non-Emergency Medical Transportation (NEMT) for members enrolled in Medicaid and Dr. Dynasaur programs.  The Transportation Team oversees and monitors NEMT, issuing policies and procedures to coincide with changing circumstances and federal and state directives.  NEMT is a statewide service for providing transportation for eligible members to and from necessary, non-emergency medical services. It is provided through a contract between the State of Vermont, Department of Vermont Health Access (DVHA) and the Vermont Public Transportation Association (VPTA).

Please note that in the Fall of 2020 these Teams (formerly known as the Coordination of Benefits (COB) Unit) and the Provider Member Relations (PMR) Unit merged and became the Member Provider Services (MPS) Unit.

The Casualty Recovery and TPL Teams work with providers, beneficiaries, probate courts, attorneys, estate executors, health insurers, liability insurance companies, employers, third party administrators (TPA) and Medicare A, B, C & D plans to ensure that Medicaid is the payer of last resort and that all possible types of recovery are pursued as required by federal law.   

The Tranportation and Provider Teams serves members enrolled in Medicaid and Dr. Dynasaur programs, as well as all providers enrolled with Vermont Medicaid.  The teams also serve internal stakeholders such as Gainwell Technologies, Division of Aging and Independent Living, as well as other departments within the Agency of Human Services.

The Casualty Recovery Team assists Medicare beneficiaries with state health/pharmacy assistance obtain their prescription medications at the pharmacy, eligibility for pharmacy assistance, premium assistance, Low Income Subsidy (LIS), Medicare buy-in, and Medicare Open Enrollment.   The assistance given by this team saves beneficiaries monies and allows them to access necessary pharmacy medications at a reasonable cost, while at the same time it saves the State of Vermont millions.  Ensuring that beneficiaries are receiving all of the federal programs (Medicare Buy-in, LIS PART D Coverage) for which they are eligible, means the State of Vermont will not be responsible for the costs of the services/items in the Medicaid budget. 

The TPL Team recovers monies that Medicaid has paid as the primary insurer in error, that Medicaid has paid for the care of a beneficiary 55 years of age of older, who received long term care services or that Medicaid has paid for care for a beneficiary with another liable third party.  The collections from the recovery processes are utilized to offset program costs in the yearly Medicaid budget.  The updates done to systems to ensure correct claims processing properly, prevents Medicaid from being the primary payer in error, saving the program hundreds of millions of dollars annually.

The Transportation and Provider Teams work with members of Vermont Medicaid to ensure that they have access to covered services as well as ensuring that the provider community is actively engaged with DVHA.

SFY23 priorities are to:

• Team alignment, team building, collaboration
• Create implementation plan for Provider Management Module
• Develop timeline for online third-party liability service