Michigan Laws 550.283 – Determination that health coverage recipient is also medical assistance recipient; information to be provided by health insurer
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 550.283
- Department: means the department of community health. See Michigan Laws 550.281
- Entity: means a health insurer; a health maintenance organization; a nonprofit health care corporation; a managed care corporation; a preferred provider organization; an organization operating pursuant to the prudent purchaser act, 1984 PA 233, MCL 550. See Michigan Laws 550.281
- Medical assistance: means the medical assistance program administered by the state under the social welfare act, 1939 PA 280, MCL 400. See Michigan Laws 550.281
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(1) An entity shall provide on a monthly basis to the department, in a format determined by the department, information necessary to enable the department or entity to determine whether a health coverage recipient of the entity is also a medical assistance recipient.
(2) If a health coverage recipient of the entity is also a medical assistance recipient, the entity shall do all of the following by not later than 180 days after the department’s request:
(a) Pay the department for, or assign to the department any right of recovery owed to the entity for, a covered health claim for which medical assistance payment has been made.
(b) Respond to any inquiry by the department concerning a claim for payment for any health care item or service that is submitted not later than 3 years after the date the health care item or service was provided.
(3) An entity shall not deny a claim submitted by the department solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the time the health care item or service that is the basis of the claim was provided so long as both of the following apply:
(a) The claim is submitted to the entity within 3 years of the date that the health care item or service that is the subject of the claim was provided.
(b) Any action by the state to enforce its rights under this subdivision is commenced within 6 years of the date that the health care item or service that is the subject of the claim was provided.