TMPPM 2011 > Children's Services Handbook > Texas Health Steps (THSteps) Dental > Claims Filing and Reimbursement > Third Party Resources (TPR)

4.5.2 Third Party Resources (TPR)

For THSteps and ICF-MR dental claims, TMHP is responsible for determining if a third party resource (TPR) exists and for recouping payment from the TPR.

When the client's Medicaid Identification Form (Form H3087) shows a P in the TPR column indicating the presence of other health insurance, THSteps and ICF-MR dental providers are not required to pursue TPR. The P does not distinguish between medical or dental. Dental providers are to submit claims to TMHP for reimbursement.

THSteps providers should not submit claims to private insurance for dental services. THSteps and ICF-MR dental providers should file the claim directly to TMHP even if the provider knows that the client has private insurance. TMHP will reimburse the claim and pursue payment from any other TPR. If a recoupment is made from another payment resource, TMHP will make the appropriate post-payment reconciliation with the dental provider.

Refer to: "Automated Inquiry System (AIS)" in "Preliminary Information" (Vol. 1, General Information).