Medicare and Medicaid Requests for Reimbursement and
Release of Information
O.A.C. 5160-1-08; O.A.C. 4123-3-23; and 42 U.S.C.§ 1395y(b)(2)
Shannon, Chief of Claims Policy & Support
Management policies, directives and memos regarding Medicare and Medicaid
request for reimbursement and release of Information claims that predate the
effective date of this policy.
versions of the policy are available upon request
I. POLICY PURPOSE
purpose of this policy is to provide direction on how to respond to inquiries
from Medicare, Medicaid and its agents requesting reimbursement or release of
information from the Bureau of Workers’ Compensation (BWC) for injured workers (IW)
with allowed Ohio workers’ compensation claims.
policy applies to the staff of BWC and the MCOs.
the claim service specialist (CSS) receives a Medicare request for reimbursement from the Centers for Medicare and
Medicaid Services (CMS), a private collection agency on behalf of CMS or from
the MCO, the CSS should email
the request to the BWC Medicare Medical email box at BWCMedicareMedical@bwc.state.oh.us. Direct questions to BWC Medicare Medical telephone
number at (614) 902-4072.
When Medical Billing and Adjustments (MB&A) receives a Medicare request for reimbursement, they will
ensure that there is an image of the request in the claim file, research and
respond to the request.
the IW or the IW’s representative requests assistance due to the denial by CMS
or Medicare Benefits Coordination & Recovery Center (Medicare BCRC) of a medical
service or medical equipment request, the CSS or medical claim specialist (MCS)
Send the request for assistance regarding denial of service issues to the
BWC Medicare Inquiries email box at INQUIRIES.M.email@example.com or complete a Medicare Referral Form and
send to BWC Medicare Inquiries email box.
Include the following
information on the Medicare Referral Form or in the email:
Verified IW’s home
address in PowerSuite.
If the IW’s address
is incorrect, the CSS or MCS should provide the correct home address for the
If the IW’s home
address cannot be located, the CSS or MCS should contact the IW to obtain the
IW’s correct home address.
the CSS receives a request for Medicaid reimbursement, the
CSS should do the following:
the Medicaid Recovery request
into the claim file in the document management system and title the request,
“Medicaid Recovery Request”;
the Medicaid request for
reimbursement to the MCO managing the IW’s medical care; and
in the claims management system that the Medicaid request for
reimbursement was sent to the MCO.