Sec. 10.09.83.04. Notice to the Department

A. An attorney representing a recipient in a cause of action that gives rise to the Department’s right of subrogation under Regulation .02 of this chapter shall notify the Program’s Division of Recoveries and Financial Services in writing before:

(1) Filing a claim;

(2) Commencing an action; or

(3) Negotiating a settlement.

B. The notice required under §A of this regulation shall include submission of the following information:

(1) The recipient's name, Social Security Number, date of birth, last known address, and telephone number;

(2) The name of any person against whom the recipient is making a claim;

(3) The identification of each potentially liable third party, including that party's name, last known address, and telephone number;

(4) The name of any insurer of any person against whom the recipient is making a claim, if known;

(5) The date of the injury or illness giving rise to the claim;

(6) A short statement identifying the nature of the recipient’s claim or the terms of any settlement, judgment or award;

(7) Copies of the pleadings and other papers related to the action or claim; and

(8) A valid release of the confidentiality of the recipient’s medical records from the date of the injury until the date of the notice.

C. In any action or claim by a recipient to recover damages for an injury or illness that has resulted in the Department providing or paying for Program benefits, an attorney who represents a recipient shall give the Program’s Division of Recoveries and Financial Services written notice:

(1) Not later than 30 calendar days after any judgment or award in such action or claim; or

(2) Before the resolution of the cause of action or claim.

D. In addition to the notices required in §§A and C of this regulation, an attorney required to give notice under §A or C of this regulation shall give the Program’s Division of Recoveries and Financial Services additional written notice not later than 30 calendar days after judgment, award, or settlement of the action or claim stating the amount and terms of any judgment, award, or settlement of the action or claim.

E. Upon receiving the notice required pursuant to §A of this regulation, the Department shall, within 3 business days, acknowledge in writing its claim to the recipient or the attorney of the recipient and to the third party. The Department shall provide the amount of the claim and an itemized list of charges within 15 business days pursuant to Regulation .06 of this chapter. Nothing herein shall prevent the Department from thereafter updating the amount of the claim and itemized list of charges within a reasonable time after the recipient’s provider notifies the Department of additional charges.

F. Upon receiving the notice required pursuant to §A of this regulation, the Department shall, within 3 business days, advise the recipient or the attorney of the recipient and the third party, in writing, whether the recipient is:

(1) A Medicaid recipient;

(2) A member of a Medicaid Managed Care Organization (MCO); or

(3) Not a Medicaid recipient.

G. Under Regulation .06 of this chapter, the Department shall provide the amount of the claim and an itemized list of charges within 15 business days of receipt of the notice required under §A of this regulation. Nothing in this regulation shall prevent the Department from updating the amount of the claim and itemized list of charges within a reasonable time after the recipient’s provider notifies the Department of additional charges.