How the ISO ClaimSearch Medicaid Reporting Service Works
To participate in the ISO ClaimSearch® Medicaid Reporting Service, simply report to ISO ClaimSearch as usual, using Universal Format. The system will conduct searches of claimants against Rhode Island's Medical Assistance Intercept System (MAIS) database using name and address, name and date of birth, and Social Security number.
The service will send matching claims to MAIS to verify that:
- the claimant is a Rhode Island Medicaid beneficiary with an open bodily injury claim against the insurer
- Rhode Island Medicaid has made payments related to the accident
- the Medicaid payments are related to the injury in the claim
Once MAIS verifies that the claimant is a Medicaid recipient, MAIS will issue either a "lien" or "no-lien" document. If MAIS determines that Medicaid has made medical payments related to a claim, then the initial document will be a lien notice containing the lien amount. Both lien and no-lien documents are good for 30 days. After 30 days, the insurer or attorney can request an updated document.
The insurer should:
- Check the MAIS database before settling the claim to obtain an updated lien or no lien document, if the original document is beyond its 30-day expiration period.
- make payment separately, as an offset, to the Rhode Island Executive Office of Health and Human Services (EOHHS)
- pay the balance of the settlement to the claimant directly or through his or her attorney
If the insurer or claimant takes issue with the amount or scope of the lien, there is an appeal process through the EOHHS. The insurer can request an appeal within 30 days of notification of the lien amount. If there is an appeal, payment to the claimant will occur after the hearing.
Once the insurer makes a payment to EOHHS to satisfy the lien, no other payment is required. The legislation includes immunity provisions for the insurer, the database provider, and MAIS.
Get started now
To access the ISO ClaimSearch Medicaid Reporting Service, complete the form on the right. For questions, contact us at:
- Phone: 1-800-888-4476
- E-mail: firstname.lastname@example.org