4-002.03 Cooperation in Obtaining Third Party Payments

As a condition of eligibility for medical assistance, the client must cooperate in obtaining third party payments unless s/he has good cause for non- cooperation (see 468 NAC 4-002.03B3 ff.). Cooperation includes any or all of the following:

1. Providing complete information regarding the extent of third party coverage which s/he or any other unit member has or may have. This includes coverage provided by a person not in the unit or by an agency;
2. Providing any additional information or signing claim forms which may be necessary for identification and collection of potential third party payments;
3. Appearing as a witness in a court or another proceeding, if necessary;
4. Notifying the Department of any action s/he is initiating to recover money from a liable third party for medical care or services. This includes the identity of the third party as well as the entire amount of any settlement, court award, or judgment;
5. Reimbursing the Department or paying to the provider any payments received directly from a third party for any services payable by NMAP; and
6. Taking any other reasonable steps to secure medical support payments.

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4-002.03A Refusal to Cooperate

4-002.03B Opportunity to Claim Good Cause

4-002.03C Sanction for Refusal to Cooperate