Reference Document:  913.1 TL-138 [PDF] Third Party Liability (TPL)

The purpose of this Bulletin is to further delineate the above referenced policy by outlining the process that providers will use to verify consumer income.

Income verification must be done on all consumers at enrollment in order to determine if co-payment is applicable.  This information is to be entered in eCura (provider connect) on the Quarterly Events Screen and updated quarterly as required.

Applicability: Uninsured consumers subject to section 6c of DMH Policy 913.1.

a. Providers will obtain the following information from all new consumers upon enrollment and enrolled consumers when updating the quarterly events screen (see attached screen shot).
b. Household Annual income
c. Number of dependants in household as defined in DMH Policy  913.1

1.   If the enrollment is done by the Access Help Line (AHL) the Core Service (CSA) shall complete the income verification at the first clinic visit.  AHL staff will instruct the consumer to bring proof of income (refer to Policy 913.1) to their first clinic visit.
2. Upon CSA completion of the quarterly event screen, eCura will overnight automatically assign a co-pay benefit plan to consumer records that qualify.  Consumers will be either assigned a $0 or $2 co-payment.
3. Once the benefit plan has been assigned, eCura will automatically deduct the co-pay amount from the total amount for each eligible service provided. Please refer to Policy 913.1 for specific eligible services. The provider will be paid the balance after the co-pay has been deducted i.e. the consumer receives 4 units of community support and 2 units of medication somatic services within a given day in this instance only one (1) co-payments is taken per service received.  Since two (2) services were rendered a total of $4.00 is to be collected.
4. Provider will collect the $2.00 co-payment from consumer for each service rendered/day.