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

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

10.4May 2022

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Partners
  • Medicaid Beneficiaries
  • Attorneys
  • DMV
Story Behind the Curve

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

Attorneys 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. Interaction begins with the client informing their attorney that they are covered by Medicaid, or by a returned Accident/Questionnaire which discloses an involved attorney.  The team works with attorneys 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. The response time jumped again in December 2021 due to an increase in requests, staff pulled for other project work, and staff shortages. The team continues to receive a steady increase in workload. As a result, there continues to be an increase in response time to both attorney’s and insurances.

Narrative last updated:  03/23/22

Strategy

In January 2021, the Casualty Recovery Team assigned a particular person to work with attorneys based on members last name and began working with DVHA Data unit to receive accident case reports from Department of Motor Vehicles (DMV) monthly.  The team believes these strategies will decrease the number of response days and that the collaboration with the DMV will result in faster recovery of monies for the State of Vermont.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy