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Subrogation Demand claims

Updated on April 26, 2021

Subrogation Demand refers to the process that an insurance company uses to seek reimbursement for a claim that it has already paid to the responsible party. Subrogation Demands Claims are important to an Insurance company if another party is actually responsible for all or part of the charges. In such cases, the insurance company or party who receives the claims may pay the claim, and then seek reimbursement from the other party.

Situations exist when a patient, who has a primary coverage and Medicaid as a secondary coverage (last payer), tells the provider only about the Medicaid insurance. The service is rendered and the provider bills Medicaid as primary. Medicaid pays the claim as the sole payer (“pays out of turn”) and later determines that the patient actually had primary insurance. To reclaim monies, states submit claims to the primary insurance after reconciliation of eligibility files.

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