Common use of Third Party Liability & Coordination of Benefits Clause in Contracts

Third Party Liability & Coordination of Benefits. (a) EOHHS is responsible for adjudicating the Cost Share Obligations under the State Plan. The MA Health Plan will adjudicate and pay claims in accordance with Medicare rules and regulations and provide evidence of payment information to providers, which identifies coordination amounts for their claim submission to the State Plan. Pursuant to the State Plan, EOHHS will remain financially responsible for Cost-Sharing Obligations and Medicaid Benefits for Dual Eligible Members. EOHHS may have financial responsibility for Medicare Part A and/or Part B premiums for Dual Eligible Member. EOHHS is not responsible for payment of Medicare Advantage premiums for mandatory or optional Supplement Benefits, unless specifically prescribed in the State Plan.

Third Party Liability & Coordination of Benefits. (a) EOHHS is responsible for adjudicating the Cost Share Obligations under the State Plan. The MA Health Plan will adjudicate and pay claims in accordance with Medicare rules and regulations and provide evidence of payment information to providers, which identifies coordination amounts for their claim submission to the State Plan. Pursuant to the State Plan, EOHHS will remain financially responsible for Cost-Sharing Obligations and Medicaid Benefits for Dual Eligible Membersmembers. EOHHS may have financial responsibility for Medicare Part A and/or Part B premiums for Dual Eligible Membermember. EOHHS is not responsible for payment of Medicare Advantage premiums for mandatory or optional Supplement Benefits, unless specifically prescribed in the State Plan.