Casualty Third Party Liability (TPL)

Casualty TPL subrogation is responsible for collecting funds paid out by Vermont Medicaid when another party is found responsible for payment, such as, a property insurance, auto insurance, workers compensation insurance, or another responsible party.

Please complete the New Request Form below for each individual Medicaid member and specific incident. The information contained is required for us to complete the lien and notify the correct parties.

Attorney's NOTE: HIPAA mandates that DVHA also must receive a copy of your client's signed Medical Release Authorization Form.


Question & Answer (Q&A)

Q: What do I need to do to start a new case?

A: Attorney’s, please send a letter of representation, a signed medical authorization (HIPAA release), and a new case form to return via email: AHS.DVHACOBTPL@vermont.gov or fax: 802-241-9070. The New Request Form can be found above.

A: Insurance companies, please fill out our new case form and return via email: AHS.DVHACOBTPL@vermont.gov or fax: 802-241-9070. The New Request Form can be found above.

Q: What is needed for a reduction request?

A:  A written request for a reduction

  • Settlement amount
  • Date of settlement
  • Itemized list of expenses incurred (if applicable)

Q: How do I submit a revision request/remove unrelated claims?

A: For unrelated claims, please use the claim summary sheet the Casualty Team sent with the claim letter and identify the claims that are not part of the injury (Circle, Star, etc.) and email or fax back to the casualty team. Also, provide a summary of why the claims marked are unrelated.


Please send communications to:

Email:

AHS.DVHACOBTPL@vermont.gov

Fax:

802-241-9070

Mail:

Department of Vermont Health Access

Member/Provider Services Unit – Casualty Team

280 State Drive, NOB 1 South

Waterbury, VT 05671-4020

If any questions, please contact:

  • Faith Sicard, CPC, CFPC
    DVHA Program Consultant
    AHS.DVHACOBTPL@vermont.gov
    P: 802-241-9333             
    F: 802-241-9070 
  • Tracy Wells, CPC, CPB                             
    DVHA Program Consultant                          
    AHS.DVHACOBTPL@vermont.gov
    P: 802-241-9340                                               
    F: 802-241-9070   
  • Samantha Prince, BSHCM, COC, CPC, CPB, CPMA
    COB Supervisor
    Samantha.Nye@vermont.gov
    P: 802-241-9330
    F: 802-241-9070                                                                                                                  

Department of Vermont Health Access

280 State Drive
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260

Department Contact List for customer service, program telephone and fax numbers, and staff email

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Public Record Requests
Kelly Provost
DVHA Public Records Officer
AHS.DVHALegal@Vermont.gov
Visit the Agency of Administration site for the Public Records Database

Report Medicaid Fraud, Waste, and Abuse