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December 2016 Texas Medicaid Provider Procedures Manual

Section 8: Third Party Liability (TPL) : 8.2 Verifying a Client’s TPR

8.2
Client TPR and other insurance information may be verified using the Your Texas Benefits Medicaid card website at www.YourTexasBenefitsCard.com.
To ensure receipt of TPR disposition of payment or denial, providers must obtain an assignment of insurance benefits from the client at the time of service. Providers are asked not to provide claim copies or statements to the client.
Providers that are aware that a client has other health insurance that is not indicated on the Your Texas Benefit Medicaid card website must notify TMHP of the details concerning the type of policy and scope of benefits.
Providers can notify TMHP by calling TPR at 1-800-846-7307, sending a fax to 1-512-514-4225, or mailing the Other Insurance Form to the following address:
Texas Medicaid & Healthcare Partnership
Third Party Resources Unit
PO Box 202948
Austin, TX 78720-2948
Any indemnity insurance policy that pays cash to the insured for wages lost or for days of hospitalization rather than for specific medical services is considered a TPR if the policy is assignable to someone else. The Health and Human Services Commission (HHSC) has assignment to any Medicaid applicant's or client's right of recovery from a third party health insurer, to the extent of the cost of medical care services paid by Medicaid. Texas Medicaid requires a provider take all reasonable measures to use a client's TPR before billing Medicaid.
Medicaid-eligible clients may not be held responsible for billed charges that are in excess of the TPR payment for services covered by Texas Medicaid. If the TPR pays less than the Medicaid-allowable amount for covered services, the provider should submit a claim to TMHP for any additional allowable amount.

Texas Medicaid & Healthcare Partnership
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