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December 2016 Texas Medicaid Provider Procedures Manual

Section 8: Third Party Liability (TPL) : 8.3 TPR Sources : 8.3.1 Exceptions : 8.3.1.1 Adoption Cases

8.3.1.1
Texas Medicaid, not the adoption agency, should be billed for all medical services that are a benefit of Texas Medicaid. If a claim is inadvertently sent to the adoption agency before it is sent to TMHP, TMHP must receive the claim within 95 days of the date of disposition from the adoption agency denial, payment, requests for refund or recoupment, to be considered for payment.
If the adoption agency inadvertently makes a payment for services that are covered by Medicaid, the provider must refund the payment to the agency.
Refer to:
A copy of the non-TPR disposition must be submitted with the claim and received at TMHP within 95 days of the date of the disposition (denial, payment, request for refund, or recoupment of payment by the non-TPR source).

Texas Medicaid & Healthcare Partnership
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