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 and submit the secure online 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.
- New Request Form (secure webform)
Attorney's NOTE: HIPAA mandates that DVHA also must receive a copy of your client's signed Medical Release Authorization Form.
*DVHA allows 6 months for filing of a claim* Please contact us at AHS.DVHACasualty@vermont.gov if you have any questions about claims submission.
Question & Answer (Q&A)
Q: What do I need to do to start a new case?
A: Attorney’s, please complete the New Request Form found above and attach a letter of representation and a signed medical authorization (HIPAA release).
A: Insurance companies, please fill out our new case form found above.
Q: What is needed for a reduction request?
A: A written request for a reduction, including:
- Settlement amount (in dollars, not percent)
- Date of settlement
- The attorney's fee (in dollars, not percent)
- 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.DVHACasualty@vermont.gov Please note new email address!
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.DVHACasualty@vermont.gov
P: 802-241-9333
F: 802-241-9070 - Tracy Wells, CPC, CPB
DVHA Program Consultant
AHS.DVHACasualty@vermont.gov
P: 802-241-9340
F: 802-241-9070 - Samantha Prince, BSHCM, COC, CPC, CPB, CPMA
COB Supervisor
Samantha.Prince@vermont.gov
P: 802-241-9330
F: 802-241-9070