Member & Provider Services Unit: Coordination of Benefits

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

17.8Sep 2020

Line Bar
Notes on Methodology

Please note that in the chart above:

  • The solid trend line shows the average # of business days to respond to an attorney’s request
  • The dotted trend line shows the average # of business days to respond to an insurance company’s request

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

State of Vermont Legislation passed Title 33 VSA 1910 (amended) which enhances the ability to collect from third party payers by establishing procedures which third party payers must adhere to in the State of Vermont. Attorneys representing clients that are Vermont Medicaid members must follow Vermont Statute 33 V.S.A. § 1910: Liability of third parties; liens: "(c) A recipient who has applied for or has received medical assistance under this subchapter and the recipient's attorney, if any, shall cooperate with the agency by informing the agency in writing within a reasonable period of time after learning that the agency has paid medical expenses for the recipient. The recipient's attorney shall take reasonable steps to discover the existence of the agency's medical assistance."

Attorneys outreach our Coordination of Benefits (COB) Casualty Recovery Team via phone, fax, email and snail mail to verify Medicaid coverage of their client and vice versa. This can begin with the client informing their attorney that they are covered by Medicaid, or by a returned Accident/Questionnaire, which states that the member has retained an attorney after a trauma related injury. Once the COB Unit receives an attorney’s request for information, it has 45 days to respond. However, the goal has always been a timely and accurate response to all requests.

July 2017 results were a bit higher due to a couple of cases that had increased turn-around times. Sometime there are difficulties connecting with attorneys. Also, COB will not release information until a copy of an Authorization to Release Information form is received. This can increase the time to case closure.

The insurance days appear so low because the annual DMV data match was figured in on the date the data was run.

June 2020 results were higher because we switched our focus to the end of state fiscal year accounting and processing of checks. We were also short staffed.

Last updated:  10/15/2020

Strategy

The Coordination of Benefits (COB) Casualty Recovery Team will work requests for both attorney’s and insurances in chronological order as the requests come into the unit. Prior to 10/01/2018 attorney request were prioritized before insurance company requests.

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