Providers shall make all reasonable efforts to determine if there is a liable third-party source, including Medicare, and in the case of a liable third-party source, utilize that source for payments and benefits prior to applying for Medicaid payments. Third party payments received after billing Medicaid for service for a Medicaid recipient shall be refunded to the Alabama Medicaid Agency.

Author: Mattie Jackson, Associate Director, Specialized Waiver Unit, LTC Healthcare Reform Unit

Statutory Authority: 42 CFR, Section 433, Subpart D – Third Party Liability.

History: New Rule: Filed March 21, 2022; Effective May 15, 2022.