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.
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). 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). 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). 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). 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. 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. Validation: Per 42 CFR §438.320, the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. Voluntary: Refers to situations where the Department cannot or does not require Medicaid members to enroll in a PIHP. Waste: The unnecessary incurrence of costs as a result of inefficient or inaccurate practices, systems or controls. Wisconsin Statewide Health Information Network (WISHIN): Wisconsin’s health information network that shares electronic health information securely between participating physicians, clinics, hospitals, pharmacies, clinical laboratories, and Health Maintenance Organizations (HMOs) across the state. Wisconsin Tribal Health Directors Association (WTHDA): The coalition of all Wisconsin American Indian Tribal Health Departments.
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). 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 care: Doctor, clinic, health center, or other place that an individual reports visiting when sick. Persons who report the emergency department as the place of their usual source of care are defined as having no usual source of care. Validation: Per 42 CFR §438.320, the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. Voluntary: Refers to any service area where the Department cannot require members to enroll in a HMO.
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:
