USHAI 103P-2 Procedures after the Utah State Hospital Case is Opened – Adult and Private Insurance

01/03 Revised 03/13/03


H50A – Notice of Responsibility for Payment


Once the patient case has been opened and all pertinent information obtained, determine if a Notice of Responsibility for Payment (form H50A) is necessary.  Send the H50A to the patient in care of the USH.  If the patient is married, send a separate H50A to the spouse at their mailing address by certified mail.  See USHAI 360 Notice of Responsibility for payment for further information.  If it is not appropriate to send the H50A to the patient, close the patient’s case (refer to USHAI 061 Case Closure for further information); however, if the patient has insurance coverage, proceed with collections from the patient’s insurance company.