Third Party Liability (TPL). The Contractor must comply with the Third-Party Liability (TPL) procedures set forth at Section 1902(a)(25) of the Social Security Act, 42 U.S.C. § 1396(a)(25), and implemented by the Department. Under this Agreement, the Third-Party Liability responsibilities of the Department will be allocated between the Department and the Contractor.
Third Party Liability (TPL). The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims. Trade Secret: Per Wis. Stat. 134.90(1), trade secrets are information, including a formula, pattern, compilation, program, device, method, technique or process to which all of the following apply: 134.90(1)(c)1.1. The information derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use. 134.90(1)(c)2.2. The information is the subject of efforts to maintain its secrecy that are reasonable under the circumstances. Trading Partner: Refers to a provider or PIHP that transmits any health information in electronic form in connection with a transaction covered by 45 CFR Parts 160 and 162, or a business associate authorized to submit health information on the Trading Partner’s behalf. Transaction: The exchange of information between two parties to carry out financial or administrative activities related to health care as defined by 45 CFR Part 160.103. Transitional Care: Processes to ensure continuity of care that include, but are not limited to, medication reconciliation, ensuring members have a comprehensive understanding of their treatment plan, and assisting members with scheduling follow-up appointments with their primary care provider or specialists as needed after a member is discharged from an emergency department, hospital, nursing home, or rehabilitation facility or when a member is leaving out of home care or leaving the Xxxxxx Care Medical Home. Per 42 CFR § 438.208(b)(2), processes to coordinate services the PIHP furnishes to the member between settings of care, including appropriate discharge planning for short term and long-term hospital and institutional stays. Trauma-informed Care: An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. Urgent care/service needs: Services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services are often but not always those that if not fulfilled could result in an emergency room visit or inpatient admission...
Third Party Liability (TPL). 3.5.11.1.1 The Contractor must comply with the TPL procedures described in Section 3.18.3 of this Contract.
Third Party Liability (TPL). Any amount due for all or part of the cost of medical, behavioral health, or long-term care services from a third party.
Third Party Liability (TPL). The PCO must comply with the TPL requirements.
Third Party Liability (TPL). The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims (see Addendum IV, A for additional definitions pertaining to TPL). Trade Secret: Per Wis. Stat. 134.90(1), trade secrets are information, including a formula, pattern, compilation, program, device, method, technique or process to which all of the following apply: • 134.90(1)(c)1.1. The information derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use. • 134.90(1)(c)2.2. The information is the subject of efforts to maintain its secrecy that are reasonable under the circumstances. Trading Partner: Refers to a provider or HMO that transmits any health information in electronic form in connection with a transaction covered by 45 CFR Parts 160 and 162, or a business associate authorized to submit health information on the Trading Partner’s behalf. Transaction: The exchange of information between two parties to carry out financial or administrative activities related to health care as defined by 45 CFR Part 160.103. Transitional Care: Processes to ensure continuity of care that include, but are not limited to, medication reconciliation, ensuring members have a comprehensive understanding of their treatment plan, and assisting members with scheduling follow-up appointments with their primary care provider or specialists as needed after a member is discharged from an emergency department, hospital, nursing home, or rehabilitation facility. Per 42 CFR § 438.208(b)(2), processes to coordinate services the HMO furnishes to the member between settings of care, including appropriate discharge planning for short term and long-term hospital and institutional stays. Trauma-informed Care: An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. Urgent care/service needs: Services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services are often but not always those that if not fulfilled could result in an emergency room visit or inpatient admission. Usual sources of ca...
Third Party Liability (TPL). The legal responsibility of another individual or entity to pay for all or part of the services provided to Enrollees under the Contract (see 1 TAC §354.2301 et seq., relating to Third Party Resources).
Third Party Liability (TPL) a. Coordination of Benefits - When a claim is denied due to TPL, the MCP must timely share appropriate and available information regarding the third party to the provider for the purposes of coordination of benefits, including, but not limited to TPL information received from ODM.
Third Party Liability (TPL) is revised to add the following:
Third Party Liability (TPL). DVHA will be responsible for identifying and pursuing accident insurance and estate recovery and all other sources of third party liability (TPL). DVHA’s process for identification of potential sources of third-party liability must include identification and review of claims with diagnosis codes indicative of trauma, or injury, poisoning and other consequences of external causes. AHS shall monitor DVHA’s experience in identifying sources of third party liability or coverage and in collecting funds due to it through these sources.
