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New Reporting Requirements

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  • Sherri
    Hi Larry, Just as a follow up, I was under the impression that all carriers / tpa s had to provide at minimum, the claimant s full name, date of birth, social
    Message 1 of 10 , Jan 27, 2010
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      Hi Larry,

      Just as a follow up, I was under the impression that all carriers / tpa's had to provide at minimum, the claimant's full name, date of birth, social security number and medicare HIC number, on all new no fault claims; If they failed to do so a fine of $1,000 would be imposed, is that correct?

      I am unsure what to do in the cae of illegal aliens filing no fault claims. Would you just advise medicare of their full name and DOB and let them know no additional information exists and would that absolve you of any civil penalty ?

      Thanks again,
      Sherri
    • Sherri
      thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are
      Message 2 of 10 , Jan 27, 2010
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        thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?

        Thanks

        --- In TheRogakReport@yahoogroups.com, SEIDELDAN@... wrote:
        >
        >
        > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
        >
        > Dan Seidel
        >
        >
        >
        >
        >
        >
        > -----Original Message-----
        > From: Sherri <mshlyn01@...>
        > To: TheRogakReport@yahoogroups.com
        > Sent: Mon, Jan 25, 2010 4:39 pm
        > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
        >
        >
        >
        >
        > Hi Larry,
        >
        > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
        >
        > In other words if you are an illegal alien and cannot prove status the claim can be denied?
        >
        > Thanks again,
        > Sherri
        >
        > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
        >
        > --- In TheRogakReport@yahoogroups.com, "Sherri" <mshlyn01@> wrote:
        > >
        > > Hi Larry,
        > >
        > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
        > >
        > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
        > >
        > > Thanks so much,
        > > Sherri
        > >
        > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
        > >
        >
      • SEIDELDAN@AOL.COM
        haven t thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this
        Message 3 of 10 , Jan 27, 2010
        • 0 Attachment
          haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#.  The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
           
          Interesting hole created by this new reg.
           
          If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
           
          Dan Seidel 

          The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak


          -----Original Message-----
          From: Sherri <mshlyn01@...>
          To: TheRogakReport@yahoogroups.com
          Sent: Wed, Jan 27, 2010 3:10 pm
          Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements

           
          thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?

          Thanks

          --- In TheRogakReport@ yahoogroups. com, SEIDELDAN@.. . wrote:
          >
          >
          > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
          >
          > Dan Seidel
          >
          >
          >
          >
          >
          >
          > -----Original Message-----
          > From: Sherri <mshlyn01@.. .>
          > To: TheRogakReport@ yahoogroups. com
          > Sent: Mon, Jan 25, 2010 4:39 pm
          > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
          >
          >
          >
          >
          > Hi Larry,
          >
          > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
          >
          > In other words if you are an illegal alien and cannot prove status the claim can be denied?
          >
          > Thanks again,
          > Sherri
          >
          > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
          >
          > --- In TheRogakReport@ yahoogroups. com, "Sherri" <mshlyn01@> wrote:
          > >
          > > Hi Larry,
          > >
          > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
          > >
          > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
          > >
          > > Thanks so much,
          > > Sherri
          > >
          > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
          > >
          >

        • SEIDELDAN@AOL.COM
          I agree with Larry. No penalty if no info can be gleaned. just question of whether it has to pay or not. If clamnt does not follow rules, illegal or legal,
          Message 4 of 10 , Jan 27, 2010
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            I agree with Larry. No penalty if no info can be gleaned. just question of whether it has to pay or not. If clamnt does not follow rules, illegal or legal, clmnt is is out of luck.
             
            Dan Seidel



            -----Original Message-----
            From: SEIDELDAN@...
            To: TheRogakReport@yahoogroups.com
            Sent: Wed, Jan 27, 2010 3:44 pm
            Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements

             
            haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#.  The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
             
            Interesting hole created by this new reg.
             
            If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
             
            Dan Seidel 

            The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak


            -----Original Message-----
            From: Sherri <mshlyn01@yahoo. com>
            To: TheRogakReport@ yahoogroups. com
            Sent: Wed, Jan 27, 2010 3:10 pm
            Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements

             
            thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?

            Thanks

            --- In TheRogakReport@ yahoogroups. com, SEIDELDAN@.. . wrote:
            >
            >
            > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
            >
            > Dan Seidel
            >
            >
            >
            >
            >
            >
            > -----Original Message-----
            > From: Sherri <mshlyn01@.. .>
            > To: TheRogakReport@ yahoogroups. com
            > Sent: Mon, Jan 25, 2010 4:39 pm
            > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
            >
            >
            >
            >
            > Hi Larry,
            >
            > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
            >
            > In other words if you are an illegal alien and cannot prove status the claim can be denied?
            >
            > Thanks again,
            > Sherri
            >
            > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
            >
            > --- In TheRogakReport@ yahoogroups. com, "Sherri" <mshlyn01@> wrote:
            > >
            > > Hi Larry,
            > >
            > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
            > >
            > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
            > >
            > > Thanks so much,
            > > Sherri
            > >
            > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
            > >
            >

          • Sherri
            Ok, so if you as the carrier recieve in lieu of the NF2 an N-F 5 or (UBF-1) which supplies all the information necessary to substantiate the claim, the bill
            Message 5 of 10 , Jan 27, 2010
            • 0 Attachment
              Ok, so if you as the carrier recieve in lieu of the NF2 an N-F 5 or (UBF-1) which supplies all the information necessary to substantiate the claim, the bill should be paid without penalty to the carrier, correct? (apparently the claimant was seasonal and has since left the country)
              If the carrier refuses to pay what would substantiate the denial?

              Sherri

              --- In TheRogakReport@yahoogroups.com, SEIDELDAN@... wrote:
              >
              >
              > I agree with Larry. No penalty if no info can be gleaned. just question of whether it has to pay or not. If clamnt does not follow rules, illegal or legal, clmnt is is out of luck.
              >
              > Dan Seidel
              >
              >
              >
              >
              >
              >
              > -----Original Message-----
              > From: SEIDELDAN@...
              > To: TheRogakReport@yahoogroups.com
              > Sent: Wed, Jan 27, 2010 3:44 pm
              > Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
              >
              >
              >
              >
              >
              > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
              >
              > Interesting hole created by this new reg.
              >
              > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
              >
              > Dan Seidel
              >
              >
              > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
              >
              >
              >
              > -----Original Message-----
              > From: Sherri <mshlyn01@...>
              > To: TheRogakReport@yahoogroups.com
              > Sent: Wed, Jan 27, 2010 3:10 pm
              > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
              >
              >
              >
              >
              > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
              >
              > Thanks
              >
              > --- In TheRogakReport@yahoogroups.com, SEIDELDAN@ wrote:
              > >
              > >
              > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
              > >
              > > Dan Seidel
              > >
              > >
              > >
              > >
              > >
              > >
              > > -----Original Message-----
              > > From: Sherri <mshlyn01@>
              > > To: TheRogakReport@yahoogroups.com
              > > Sent: Mon, Jan 25, 2010 4:39 pm
              > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
              > >
              > >
              > >
              > >
              > > Hi Larry,
              > >
              > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
              > >
              > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
              > >
              > > Thanks again,
              > > Sherri
              > >
              > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
              > >
              > > --- In TheRogakReport@yahoogroups.com, "Sherri" <mshlyn01@> wrote:
              > > >
              > > > Hi Larry,
              > > >
              > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
              > > >
              > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
              > > >
              > > > Thanks so much,
              > > > Sherri
              > > >
              > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
              > > >
              > >
              >
              >
              >
              >
              >
              >
              > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
              >
              > Interesting hole created by this new reg.
              >
              > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
              >
              > Dan Seidel
              >
              >
              > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
              >
              >
              >
              > -----Original Message-----
              > From: Sherri <mshlyn01@...>
              > To: TheRogakReport@yahoogroups.com
              > Sent: Wed, Jan 27, 2010 3:10 pm
              > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
              >
              >
              >
              >
              > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
              >
              > Thanks
              >
              > --- In TheRogakReport@yahoogroups.com, SEIDELDAN@ wrote:
              > >
              > >
              > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
              > >
              > > Dan Seidel
              > >
              > >
              > >
              > >
              > >
              > >
              > > -----Original Message-----
              > > From: Sherri <mshlyn01@>
              > > To: TheRogakReport@yahoogroups.com
              > > Sent: Mon, Jan 25, 2010 4:39 pm
              > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
              > >
              > >
              > >
              > >
              > > Hi Larry,
              > >
              > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
              > >
              > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
              > >
              > > Thanks again,
              > > Sherri
              > >
              > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
              > >
              > > --- In TheRogakReport@yahoogroups.com, "Sherri" <mshlyn01@> wrote:
              > > >
              > > > Hi Larry,
              > > >
              > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
              > > >
              > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
              > > >
              > > > Thanks so much,
              > > > Sherri
              > > >
              > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
              > > >
              > >
              >
            • SEIDELDAN@AOL.COM
              non compliance with verifications and failures to sign off on the assignments to the providers - the clmnt would get stuck, but since there is a go home
              Message 6 of 10 , Jan 27, 2010
              • 0 Attachment
                non compliance with verifications and failures to sign off on the assignments to the providers - the clmnt would get stuck, but since there is a "go home" status, the hospital can apply to a "pool" that pays non paid bills or eat the bill or the client gets a judgment after non collection. As long as verification procedures are complied with by the carriuer, the burden shifts to the clmnt and clmnt fails to perform, clamnt eats the bill!! Am I correct - Larry?
                 
                Dan Seidel



                -----Original Message-----
                From: Sherri <mshlyn01@...>
                To: TheRogakReport@yahoogroups.com
                Sent: Wed, Jan 27, 2010 4:29 pm
                Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements

                 
                Ok, so if you as the carrier recieve in lieu of the NF2 an N-F 5 or (UBF-1) which supplies all the information necessary to substantiate the claim, the bill should be paid without penalty to the carrier, correct? (apparently the claimant was seasonal and has since left the country)
                If the carrier refuses to pay what would substantiate the denial?

                Sherri

                --- In TheRogakReport@ yahoogroups. com, SEIDELDAN@.. . wrote:
                >
                >
                > I agree with Larry. No penalty if no info can be gleaned. just question of whether it has to pay or not. If clamnt does not follow rules, illegal or legal, clmnt is is out of luck.
                >
                > Dan Seidel
                >
                >
                >
                >
                >
                >
                > -----Original Message-----
                > From: SEIDELDAN@.. .
                > To: TheRogakReport@ yahoogroups. com
                > Sent: Wed, Jan 27, 2010 3:44 pm
                > Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                >
                >
                >
                >
                >
                > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
                >
                > Interesting hole created by this new reg.
                >
                > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
                >
                > Dan Seidel
                >
                >
                > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
                >
                >
                >
                > -----Original Message-----
                > From: Sherri <mshlyn01@.. .>
                > To: TheRogakReport@ yahoogroups. com
                > Sent: Wed, Jan 27, 2010 3:10 pm
                > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                >
                >
                >
                >
                > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
                >
                > Thanks
                >
                > --- In TheRogakReport@ yahoogroups. com, SEIDELDAN@ wrote:
                > >
                > >
                > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
                > >
                > > Dan Seidel
                > >
                > >
                > >
                > >
                > >
                > >
                > > -----Original Message-----
                > > From: Sherri <mshlyn01@>
                > > To: TheRogakReport@ yahoogroups. com
                > > Sent: Mon, Jan 25, 2010 4:39 pm
                > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                > >
                > >
                > >
                > >
                > > Hi Larry,
                > >
                > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
                > >
                > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
                > >
                > > Thanks again,
                > > Sherri
                > >
                > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
                > >
                > > --- In TheRogakReport@ yahoogroups. com, "Sherri" <mshlyn01@> wrote:
                > > >
                > > > Hi Larry,
                > > >
                > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
                > > >
                > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
                > > >
                > > > Thanks so much,
                > > > Sherri
                > > >
                > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
                > > >
                > >
                >
                >
                >
                >
                >
                >
                > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
                >
                > Interesting hole created by this new reg.
                >
                > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
                >
                > Dan Seidel
                >
                >
                > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
                >
                >
                >
                > -----Original Message-----
                > From: Sherri <mshlyn01@.. .>
                > To: TheRogakReport@ yahoogroups. com
                > Sent: Wed, Jan 27, 2010 3:10 pm
                > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                >
                >
                >
                >
                > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
                >
                > Thanks
                >
                > --- In TheRogakReport@ yahoogroups. com, SEIDELDAN@ wrote:
                > >
                > >
                > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
                > >
                > > Dan Seidel
                > >
                > >
                > >
                > >
                > >
                > >
                > > -----Original Message-----
                > > From: Sherri <mshlyn01@>
                > > To: TheRogakReport@ yahoogroups. com
                > > Sent: Mon, Jan 25, 2010 4:39 pm
                > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                > >
                > >
                > >
                > >
                > > Hi Larry,
                > >
                > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
                > >
                > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
                > >
                > > Thanks again,
                > > Sherri
                > >
                > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
                > >
                > > --- In TheRogakReport@ yahoogroups. com, "Sherri" <mshlyn01@> wrote:
                > > >
                > > > Hi Larry,
                > > >
                > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
                > > >
                > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
                > > >
                > > > Thanks so much,
                > > > Sherri
                > > >
                > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
                > > >
                > >
                >

              • Sherri
                Hi Larry, You previously indicated the following concerning the new medicare requirements: The case law and arb decisions say that if the claimant is illegal
                Message 7 of 10 , Jan 30, 2010
                • 0 Attachment
                  Hi Larry,

                  You previously indicated the following concerning the new medicare requirements:

                  The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak

                  Could you cite the case as I would love to have it for any further problems that arise, also if you know of the arb case that would be most helpful as well.

                  Thanks so much,
                  SHerri

                  --- In TheRogakReport@yahoogroups.com, SEIDELDAN@... wrote:
                  >
                  >
                  > non compliance with verifications and failures to sign off on the assignments to the providers - the clmnt would get stuck, but since there is a "go home" status, the hospital can apply to a "pool" that pays non paid bills or eat the bill or the client gets a judgment after non collection. As long as verification procedures are complied with by the carriuer, the burden shifts to the clmnt and clmnt fails to perform, clamnt eats the bill!! Am I correct - Larry?
                  >
                  > Dan Seidel
                  >
                  >
                  >
                  >
                  >
                  >
                  > -----Original Message-----
                  > From: Sherri <mshlyn01@...>
                  > To: TheRogakReport@yahoogroups.com
                  > Sent: Wed, Jan 27, 2010 4:29 pm
                  > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  >
                  >
                  >
                  >
                  > Ok, so if you as the carrier recieve in lieu of the NF2 an N-F 5 or (UBF-1) which supplies all the information necessary to substantiate the claim, the bill should be paid without penalty to the carrier, correct? (apparently the claimant was seasonal and has since left the country)
                  > If the carrier refuses to pay what would substantiate the denial?
                  >
                  > Sherri
                  >
                  > --- In TheRogakReport@yahoogroups.com, SEIDELDAN@ wrote:
                  > >
                  > >
                  > > I agree with Larry. No penalty if no info can be gleaned. just question of whether it has to pay or not. If clamnt does not follow rules, illegal or legal, clmnt is is out of luck.
                  > >
                  > > Dan Seidel
                  > >
                  > >
                  > >
                  > >
                  > >
                  > >
                  > > -----Original Message-----
                  > > From: SEIDELDAN@
                  > > To: TheRogakReport@yahoogroups.com
                  > > Sent: Wed, Jan 27, 2010 3:44 pm
                  > > Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  > >
                  > >
                  > >
                  > >
                  > >
                  > > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
                  > >
                  > > Interesting hole created by this new reg.
                  > >
                  > > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
                  > >
                  > > Dan Seidel
                  > >
                  > >
                  > > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
                  > >
                  > >
                  > >
                  > > -----Original Message-----
                  > > From: Sherri <mshlyn01@>
                  > > To: TheRogakReport@yahoogroups.com
                  > > Sent: Wed, Jan 27, 2010 3:10 pm
                  > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  > >
                  > >
                  > >
                  > >
                  > > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
                  > >
                  > > Thanks
                  > >
                  > > --- In TheRogakReport@yahoogroups.com, SEIDELDAN@ wrote:
                  > > >
                  > > >
                  > > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
                  > > >
                  > > > Dan Seidel
                  > > >
                  > > >
                  > > >
                  > > >
                  > > >
                  > > >
                  > > > -----Original Message-----
                  > > > From: Sherri <mshlyn01@>
                  > > > To: TheRogakReport@yahoogroups.com
                  > > > Sent: Mon, Jan 25, 2010 4:39 pm
                  > > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  > > >
                  > > >
                  > > >
                  > > >
                  > > > Hi Larry,
                  > > >
                  > > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
                  > > >
                  > > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
                  > > >
                  > > > Thanks again,
                  > > > Sherri
                  > > >
                  > > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
                  > > >
                  > > > --- In TheRogakReport@yahoogroups.com, "Sherri" <mshlyn01@> wrote:
                  > > > >
                  > > > > Hi Larry,
                  > > > >
                  > > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
                  > > > >
                  > > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
                  > > > >
                  > > > > Thanks so much,
                  > > > > Sherri
                  > > > >
                  > > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
                  > > > >
                  > > >
                  > >
                  > >
                  > >
                  > >
                  > >
                  > >
                  > > haven't thought that one through. wow. If no pltf atty, the claimant should be able to work this through a hospital social worker (if clmnt is told about this remedy - many times they are scared to do anything and do not know this procedure). I would think off the cuff that the carrier, if ID'ed, would be generally responsible for PIP as the legislative intent is "no fault" and if an illegal got hurt, there could be a constitutional due process argument if the carrier does not pay and if all info is provided in timely and seasonable fashion to the carrier, save for SS#. The carrier, probably to avoid the $1000 sanction for no SS# and no pay, would probably have to assist thru the nurse practitioner "helper/coordinator of benefits" getting the paperwork for the emergency medicaid Tx. That way, although a little effort is expended by the carrier, it may probably avoid paying for the claim as "conditions were not met". But the counter to that is that a carrier foot is placed into the pool and is now wet.
                  > >
                  > > Interesting hole created by this new reg.
                  > >
                  > > If no clmnt located, and clmnt failure to file timely NF papers, with or without SS#, then conditions violated, no verification, etc., therefore no pay by carrier. That would seem viable from a carrier's perspective. Clamnt would be on their own, as many times arise for failing to diligently follow up with verifications and paperwork. Laches and prejudice to the carrier if no paperwork and can not find clmnt. Clmnt in essence screwed.
                  > >
                  > > Dan Seidel
                  > >
                  > >
                  > > The case law and arb decisions say that if the claimant is illegal and has no SS #, then the inquiry ends. The insurer cannot report information that doesn't exist. There should be no penalty for the insurer if its response to Medicare is that the claimant is an illegal alien with no SS #. -- Larry Rogak
                  > >
                  > >
                  > >
                  > > -----Original Message-----
                  > > From: Sherri <mshlyn01@>
                  > > To: TheRogakReport@yahoogroups.com
                  > > Sent: Wed, Jan 27, 2010 3:10 pm
                  > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  > >
                  > >
                  > >
                  > >
                  > > thanks Dan, however, what if there is no plaintiff attorney, just the NF5 from the hospital with the medical report and the claimant cannot be located? Are the carriers responsible for payment? and can the $1000 fine be imposed to the carrier who makes payment without the ss number or visa?
                  > >
                  > > Thanks
                  > >
                  > > --- In TheRogakReport@yahoogroups.com, SEIDELDAN@ wrote:
                  > > >
                  > > >
                  > > > Morning all, if push come to shove, pltf's atty can make application for "emergency medicaid" coverage for the intitial billings for Amb, ER, Admit, etc. even if no SS and working illegally. Just finished doing that ($30,000+). Just a lot of phone work and affidavits of no insur, etc. It's a last ditch effort.
                  > > >
                  > > > Dan Seidel
                  > > >
                  > > >
                  > > >
                  > > >
                  > > >
                  > > >
                  > > > -----Original Message-----
                  > > > From: Sherri <mshlyn01@>
                  > > > To: TheRogakReport@yahoogroups.com
                  > > > Sent: Mon, Jan 25, 2010 4:39 pm
                  > > > Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: New Reporting Requirements
                  > > >
                  > > >
                  > > >
                  > > >
                  > > > Hi Larry,
                  > > >
                  > > > So when they do not provide the requested information you are able now to deny stating that we are unable to process your claim without a valid social security number or passport/visa. Will that denial hold up in court.
                  > > >
                  > > > In other words if you are an illegal alien and cannot prove status the claim can be denied?
                  > > >
                  > > > Thanks again,
                  > > > Sherri
                  > > >
                  > > > [Sherri: No, you cannot deny PIP benefits to an illegal alien. When you demand their SS number and they say they don't have one, that's your answer -- you can't delay or deny based on the lack of an SS. -- Larry Rogak]
                  > > >
                  > > > --- In TheRogakReport@yahoogroups.com, "Sherri" <mshlyn01@> wrote:
                  > > > >
                  > > > > Hi Larry,
                  > > > >
                  > > > > What happens if you receive a no fault claim from a passenger who is a UK resident and they get injured and do not reside in the states. Additionally, they are working here but apparently illegally, therefore they don't have a social security number or valid passport information to provide. Furthermore, you only have the NF5 from the hospital and the records.
                  > > > >
                  > > > > Are you as the carrier able to deny the hospital bills based on this situation, and if so how would it be worded to be effective.
                  > > > >
                  > > > > Thanks so much,
                  > > > > Sherri
                  > > > >
                  > > > > [Sherri: You demand verification just like with anybody else, process their claim based on the information they do have, and when they tell you they don't have an SS number, that answers your question. I would also demand an EUO. -- Larry Rogak]
                  > > > >
                  > > >
                  > >
                  >
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