Cost Avoidance Activities a. The Contractor shall be responsible for cost avoidance through the Coordination of Benefits (COB) for public and private resources, including but not limited to Medicare, private health insurance, Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001, et. seq., plans, and workers' compensation. The Contractor must attempt to avoid initial payment of Claims, whenever possible, where public or private resources are available. All cost• avoided funds must be reported to the Department on a form approved by the Department, showing that TPL has been pursued and the amount which has been cost- avoided. The Contractor shall not be held responsible for any TPL errors in the Department's Eligibility Verification System (EVS) or the Department's TPL file.
Cost Avoidance Activities i. The PCO must take measures to avoid initial payment of Claims, whenever possible, where federal or private insurance-type resources are available. The PCO must report all funds that are cost avoided to the Department via Encounter Data submissions. The use of the appropriate HIPAA 837 Loop(s) for Medicare and Other Insurance Paid (OIP) shall indicate that TPL has been pursued and the amount which has been cost-avoided.
Cost Avoidance Activities i. The Contractor will have primary responsibility for cost avoidance through the Coordination of Benefits (COB) relative to federal and private health insurance-type resources including, but not limited to, Medicare, private health insurance, Employees Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. 1396a(a)(25) plans, and workers compensation. The Contractor must attempt to avoid initial payment of Claims, whenever possible, where federal or private health insurance-type resources are available. All cost-avoided funds must be reported to the Commonwealth via encounter data submissions and financial report 8A-D. The use of the COB flag, Medicare fields, and the Other Insurance Paid (OIP) field shall indicate that TPL has been pursued and the amount which has been cost-avoided. The Contractor shall not be held responsible for any TPL errors in the Department's Eligibility Verification System (EVS) or the Department's TPL file. 119
Cost Avoidance Activities. 2. Post-Payment Recoveries.................................................................
