55 Pa. Code § 1163.456 - Third-party liability

In addition to the conditions set forth in Chapter 1101 (relating to general provisions) the following policies apply to third-party resources for hospital services:

(1) Sources of payment other than MA shall be researched prior to billing the Department. If a resource is found, it shall be depleted to the full extent of the liability of that resource prior to billing MA. Lifetime reserve days under Medicare are considered an available resource.

(2) If the hospital receives payment from a third party subsequent to payment from the Department, repayment to the MA Program shall be made by way of a claim adjustment.

Notes

55 Pa. Code § 1163.456

The provisions of this § 1163.456 adopted June 22, 1984, effective 7/1/1984, 14 Pa.B. 2185.

This section cited in 55 Pa. Code § 1163.451 (relating to general payment policy); and 55 Pa. Code § 1163.457 (relating to payment policies relating to out-of-State hospitals).