Common use of Third Party Benefits Clause in Contracts

Third Party Benefits. If an individual has third party benefits, the Contractor is required to provide HHSC CRS with the explanation of benefits (EOB) or denial from other pay sources(s). It is the Contractor’s responsibility to communicate with HHSC CRS staff regarding pre-authorizations or estimated third party payment prior to service delivery in order for HHSC CRS staff to provide appropriate authorization of services. Payment by a financial agent, including but not limited to self-insured plans, commercial/private insurance plans, Medicare, Medicaid, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. HHSC CRS is considered a payor of last resort.

Third Party Benefits. If an individual has third party benefits, the Contractor is required to provide HHSC CRS with the explanation of benefits (EOB) or denial from other pay sources(s). It is the Contractor’s responsibility to communicate with HHSC CRS staff regarding pre-authorizations or estimated third party payment prior to service delivery in order for HHSC CRS staff to provide appropriate authorization of services. Payment by a financial agent, including but not limited to self-insured plans, commercial/private insurance plans, Medicare, Medicaid, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. HHSC CRS is considered a payor of last resort.