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4.10.3 Medicaid Identification (Form H3087)
When Medicaid billing information is obtained from the client, the provider examines the TPR column of the Form H3087 to determine if the client has other health insurance. The following indicators may be found in the TPR column:
• "M" indicates that the client is eligible for Medicare. The provider must file with Medicare before filing with Medicaid. The "M" is followed by a Medicare claim identification number.
•"P" and "M" indicate that the client has other insurance and Medicare coverage. Both must be billed before billing Medicaid.
To ensure receipt of TPR disposition of payment or denial, the provider must obtain an assignment of insurance benefits from the client at the time of service. Providers are asked not to provide claim copies or statements to the client.
Family planning services providers are not required to bill a client's TPRs before filing the claim with TMHP. Federal regulations protect the client's confidential choice of birth control and family planning services. Confidentiality is jeopardized when seeking information from TPRs.
SHARS and Early Childhood Intervention (ECI) providers are required to bill private insurance before billing Medicaid. School districts, special education cooperatives, and ECI providers must have parental permission to bill a client's private insurance.
If the provider is aware that a client has other health insurance, and "P" is not recorded in the TPR column of the Medicaid Identification, the provider must notify TMHP of the details concerning the type of policy and scope of benefits.
Contact TPR at 1-800-846-7307 or write to the following address:
Texas Medicaid & Healthcare Partnership
Third Party Resources Unit
PO Box 202948
Austin, TX 78720-9981
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