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December 2016 Texas Medicaid Provider Procedures Manual

Section 8: Third Party Liability (TPL) : 8.6 TPL for Managed Care

Medicaid MCO and dental plan claims payments for services rendered to Texas Medicaid managed care clients are subject to the federal and state requirement for other insurance payments. As directed by HHSC, Texas Medicaid will recover payments based on claims data processed by the Medicaid MCO or dental plan.
TPR 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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