Member and Provider Services Unit: Casualty Recovery and Third Party Liability Teams

Average # of business days to respond to an insurance company's request for information

4.6Oct 2021

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Partners
  • Medicaid Beneficiaries
  • Insurance Companies
  • DMV
Story Behind the Curve

This measure is important because it illustrates the response time of the Casualty Recovery Team when an insurance company is involved in the recovery of Medicaid monies for previously paid services.

Insurance companies outreach the Member and Provider Services (MPS) Unit's Casualty Recovery Team via phone, fax, email, and snail mail to verify Medicaid coverage of their client and vice versa.  The Casualty Recovery Team works with insurance companies on requests in the received chronological order.

As illustrated in the graph, the response rate at the end of 2020 was below the targeted ten days.  This was due to a delay on our vendor’s part to forward Accident/Questionnaires to the Casualty Team, thus not allowing staff to outreach the insurance companies.  Processing time increased and then leveled off early in 2021as the team was catching up on the backlog of questionnaires and outreaching the insurance companies. The jump in response time in May 2021 was due to a staff processing error.

Last updated:  06/16/21

Strategy

In January 2021, the Casualty Team began working with the DVHA Data unit to receive accident case reports from the Department of Motor Vehicles (DMV) monthly, which allows staff to outreach the insurance companies in more timely manner. 

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