No fault claims usually have to be reported within two weeks at a maximum. In some states, it’s as soon as 48 hours. So we need to submit a claims ASAP. For medical facilities, there is usually an extra form that has to be completed to describe the details of the accident and the injuries of the patient. Because there are so many insurance carriers for no fault, sometimes the medical facility won’t have these forms, and they’ll have to be obtained from the insurance company.
Most people don’t know that any injury that occurs with a motor vehicle is considered a no fault claim. If you slam your finger in a car door, that’s no fault. If you’re injured in a car accident while on work time, that’s considered a no fault claim. If a motorcycle hits you, it’s a no fault claim, although many insurance companies won’t cover motorcycles, and those that do won’t cover motorcycles ridden out of season (some states have certain times of the year where motorcycles are supposed to be off the road).
AUTOMOBILE INSURANCE (ACCIDENT, NO-FAULT)
Under Michigan’s no-fault law, automobile insurance carriers are required to pay the medical expenses for injuries incurred in an automobile accident. However, in some instances, the insured’s automobile policy contains a rider stating that his health insurance coverage takes priority over the automobile insurance carrier’s policy. (This also applies to Coordination of Benefits riders.) In situations where more than one individual is involved in an accident, there is a possibility that multiple automobile insurance carriers are involved. As a result, the liable insurance carrier cannot always be readily identified at the time of initial medical treatment. The no-fault law is designed to designate an order of priority of liability. Providers must bill the automobile insurance carrier prior to billing Medicaid.
The order of responsibility to pay for medical expenses for automobile accidents is as follows:
** The insurance company of the injured party, regardless of whether he was in his, or any, automobile.
** The insurance company of any resident relative of the house in which the injured party also resides.
** The insurer of the owner of the vehicle occupied. For nonoccupants (pedestrians) of the vehicle, the insurer of the vehicle involved.
** The insurer of the driver of the vehicle occupied. For nonoccupants (pedestrians) of the vehicle, the insurer of the driver involved.
If a claim has been filed, providers should bill Medicaid while the other insurance claim is pending resolution. Medicaid must be billed within six months from the date of filing the no-fault claim to keep the claim active with Medicaid. Providers must bill the appropriate procedure code, date of the accident, and any other pertinent information (e.g., the identification of the other insurance of the injured party) on the claim.
Providers may directly pursue no-fault or other casualty cases and submit claims directly to the other insurance carriers. If liability is in question, Medicaid may be billed. Medicaid then pursues reimbursement from the other insurance through subrogation.
