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2012 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2. Overview of Medicaid Managed Care : 2.6 Reimbursement : 2.6.2 Third Party Liability (TPL)

2.6.2
A third-party resource (TPR) is a source of payment for services other than Medicaid, Medicaid MCOs, Medicaid dental plans, the client, or non-TPR sources. Federal and state laws require that all reasonable measures be made to use a client's TPR or other insurance to pay for most medical services before Medicaid funds are used.
MCO and dental plan claims payments for services rendered to Texas Medicaid managed care clients are subject to this federal and state requirement. Texas Medicaid will collect overpayments based on claims data processed by the MCO or dental plan.
TPL includes payments from any of the following sources:
A provider who furnishes services and participates in Texas Medicaid may not refuse to furnish services to an eligible client because of a third party's potential liability for the payment of the services.

Texas Medicaid & Healthcare Partnership
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