Mont. Medicaid Hospice Policy Manual, Policy 304

REQUIREMENTS

According to state and federal law, the State must take all reasonable

measures to determine the legal liability of third parties to pay for

health care and services covered by Medicaid.

The Medicaid Program is the payer of last resort to other insurance

programs. Medicaid does pay before Crime Victim Compensation

Funds, Indian Health Services, and Disaster Relief Funds.

If a third party source is known to the provider, the provider must bill

the third party before billing Medicaid and indicate the amount

received from the third party on the Medicaid claim. Providers must

submit a copy of the statement of payment of denial from the

resource when billing any balance.

Examples of third party resources include:

1. Medicare;

2. Veteran’s Administration Medical Payment;

3. Private Insurance;

4. TRICARE and TRICARE for Life (formerly Civilian

Health and Medical Program of the Uniformed Services-

CHAMPUS);

5. Worker’s Compensation.

Refer to Administrative Rule of Montana 37.85.407 for more

information on Third Party Liability.