Examples of Third Party Resource in a sentence
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.
The following exceptions apply to this definition: (a) a claim for which fraud is suspected; and (b) a claim for which a Third Party Resource should be responsible.
When the Contractor is aware of other Third Party Resources, the Contractor shall avoid payment by “cost avoiding” (denying) the Claim and redirecting the provider to bill the other Third Party Resource as a primary payer.
The LDSS or entity designated by the Department 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 the Contractor does not become aware of another Third Party Resource until after the payment for service, the Contractor is responsible to seek recovery from the Third Party Resource on a post-payment basis.
There is a Third Party Resource financially responsible for the services.
Schedule AD: Third Party Resource PaymentsThis Schedule provides detail regarding total claims payments and claims paid that had other coverage.
Determine if adequate policies and procedures are in place to supply the Department’s TPL Division Third Party Resources identified by the MCO or its Subcontractors, which do not appear on the Department’s TPL database, within two weeks of its receipt by the MCO in accordance with Section VII.F.5, Third Party Resource Identification of the Community HealthChoices Agreement.
Determine if adequate policies and procedures are in place to verify the validity of a resource in question supplied by the Department to the MCO timely as outlined and in accordance with Section VII.F.5, Third Party Resource Identification of the Community HealthChoices Agreement.
Schedule AH: Third Party Resource PaymentsThis Schedule provides detail regarding total claims payments and claims paid that had other coverage.