Common use of Third Party Health Insurance Determination Clause in Contracts

Third Party Health Insurance Determination. a) Point of Service (POS) The Contractor will make diligent efforts to determine whether Enrollees have third party health insurance (TPHI). The LDSS is also responsible for making diligent efforts to determine if Enrollees have TPHI and to maintain third party information on the WMS/eMedNY Third Party Resource System. If TPHI coverage is known at the POS, the Plan shall use the TPHI information to coordinate benefits (e.g., alert the provider and ask them to bill the TPHI that should be primary to the Plan). The Contractor shall make good faith efforts to coordinate benefits and must inform the LDSS of any known changes in status of TPHI insurance eligibility within five (5) business days of learning of a change in TPHI. The Contractor may use the Roster as one method to determine TPHI information.

Third Party Health Insurance Determination. a) Point of Service (POS) ). The Contractor FIDA Plan will make diligent efforts to determine whether Enrollees Participants have third party health insurance (TPHI). The LDSS is also responsible for making diligent efforts to determine if Enrollees Participants have TPHI and to maintain third party information on the WMS/eMedNY Third Party Resource System. If TPHI coverage is known at the POS, the FIDA Plan shall use the TPHI information to coordinate benefits (e.g., alert the provider Provider and ask them to bill xxxx the TPHI that should be primary to the FIDA Plan). The Contractor FIDA Plan shall make good faith efforts to coordinate benefits and must inform the LDSS of any known changes in status of TPHI insurance eligibility within five (5) business days Business Days of learning of a change in TPHI. The Contractor FIDA Plan may use the Roster as one method to determine TPHI information.