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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 4. Texas Health Steps (THSteps) Dental : 4.5 Claims Filing and Reimbursement : 4.5.2 Third Party Resources (TPR)

4.5.2
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.
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).

Texas Medicaid & Healthcare Partnership
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