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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.13 Third Party Liability (TPL) : 4.13.5 Accident-Related Claims : 4.13.5.1 Accident Resources, Refunds

4.13.5.1
Acting on behalf of HHSC, TMHP has specific rights of recovery from any settlement, court judgment, or other resources awarded to a client with Medicaid coverage (Texas Human Resources Code, Chapter 32.033). In most cases, TMHP works directly with the attorneys, courts, and insurance companies to seek reimbursement for Medicaid payments. If a provider receives a portion of a settlement for services also paid by Medicaid, the provider must make a refund to TMHP. Any provider filing a lien for the entire billed amount must contact the TPL/Tort Department at TMHP for Medicaid postpayment activities to be coordinated. A provider may not file a lien for the difference between the billed charges and the Medicaid payment. A lien may be filed for services not covered by Medicaid. A lien is the liability of the client with Medicaid coverage.
Providers should contact the TPL/Tort Department at TMHP after furnishing an itemized statement and/or claim copies for any accident-related services billed to Medicaid if they received a request from an attorney, a casualty insurance company, or a client.
The provider furnishes TMHP with the following information:
This information enables TMHP to pursue reimbursement from any settlement. Providers must use the Form 4.7, “Tort Response Form” to report accident information to TMHP. When the form is completed, providers must remit it to the TMHP TPL/Tort Department (the address and fax number are on the form).
Providers may contact the TMHP TPL/Tort Department by calling 1-800-846-7307, Option 3, sending a fax to (512) 514-4225, or mailing to the following address:
Texas Medicaid & Healthcare Partnership
TPL/Tort Department
PO Box 202948
Austin, TX 78720-2948

Texas Medicaid & Healthcare Partnership
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