Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.13 Third Party Liability (TPL) : 4.13.6 Third Party Liability - Tort

4.13.6
HHSC contracts with TMHP to administer third party liability cases. To ensure that Texas Medicaid is the payer of last resort, TMHP performs postpayment investigations of potential casualty and liability cases. TMHP also identifies and recovers Medicaid expenditures in casualty cases involving Medicaid clients.
The Human Resources Code, chapter 32, section 32.033 establishes automatic assignment of a Medicaid client’s right of recovery from personal insurance as a condition of Medicaid eligibility.
Investigations are a result of referrals from many sources, including attorneys, insurance companies, health-care providers, Medicaid clients, and state agencies. Referrals should be submitted to the following address:
TMHP TPL/Tort Department
PO Box 202948
Austin, TX, 78720-2948
Fax: (512) 514-4225
Referrals must be submitted on Form 4.5, “Authorization for Use and Release of Health Information (2 pages)” in this section.
TMHP releases Medicaid claims information when an HHSC Authorization for Use and Release of Health Information Form is submitted. The form must be signed by the Medicaid client. Referrals are processed within ten business days.
Refer to:
An attorney or other person who represents a Medicaid client in a third party claim or action for damages for personal injuries must send written notice of representation. The written notice must be submitted within 45 days of the date on which the attorney or representative undertakes representation of the Medicaid client, or from the date on which a potential third party is identified. The following information must be included:
The name and address of any health-care provider that has asserted a claim for payment for medical services provided to the Medicaid client for which a third party may be liable for payment, whether or not the claim was submitted to or paid by TMHP.
If any of the information described above is unknown at the time the initial notice is filed, it should be indicated on the notice and revised if and when the information becomes known.
An authorization to release information about the Medicaid client directly to the attorney or representative may be included as a part of the notice and must be signed by the Medicaid client. The HHSC Authorization for Use and Release of Health Information Form must be used.
HHSC must approve all trusts before any proceeds from a third party are placed into a trust.
Providers may direct third party liability questions to the TMHP TPL/Tort Contact Center at 1‑800‑846‑7307, Option 3.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.