TMPPM 2008 > Texas Medicaid Services > Dental > Third Party Resources (TPR)

19.22 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. Therefore, when clients do not have a readily available private dental insurance identification/verification, dental providers should bill TMHP for reimbursement.

THSteps providers do not have to bill private insurance for dental services. THSteps and ICF-MR dental providers unable to determine whether the client's other insurance provides coverage for dental services 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)" .