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 TMHP Third Party Liability

The Texas Medicaid & Healthcare Partnership (TMHP) contracts with the Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) to administer third-party liability cases.

To ensure that the Texas Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program is the payer of last resort, TMHP performs post-payment investigations of potential casualty and liability cases. TMHP is responsible for recovering Medicaid’s and CSHCN Services Program’s expenditures in casualty cases involving Medicaid and CSHCN Services Program clients.

The Human Resources Code, Chapter 32, §32.033 establishes automatic assignment of a Medicaid client’s right of recovery from personal insurance as a condition of Medicaid eligibility.

Investigations are a result of referrals from many sources, including attorneys, insurance companies, health-care providers, Medicaid or CSHCN Services Program clients, and state agencies. Referrals should be submitted to the following address:

TMHP Tort Department
PO Box
202948

Austin
, TX, 78720-2948
Fax: 512-514-4225

Referrals may be submitted on the Tort Response Form found in the 2008 Texas Medicaid Provider Procedures Manual, Appendix B, “Forms” on page B-113.

The HHSC Authorization for Use and Release of Health Information Form must be completed before TMHP can release any confidential medical information on Medicaid and CSHCN Services Program clients. 

An attorney or other person who represents a Medicaid or CSHCN Services Program client in a third-party claim or action for damages for personal injuries must send written notice of representation. The written notice must be submitted within 45 days of the date on which the attorney or representative undertakes representation of the Medicaid or CSHCN Services Program client, or from the date on which a potential third party is identified. The following information must be included:

  • The Medicaid or CSHCN Services Program client’s name, address, and identifying information.
  • The name and address of any third party or third-party health insurer against whom a third-party claim is or may be asserted for injuries to the Medicaid or CSHCN Services Program client.
  • The name and address of any health-care provider that has asserted a claim for payment for medical services provided to the Medicaid or CSHCN Services Program client for which a third party may be liable for payment, whether or not the claim was submitted to or paid by TMHP.

If any of the information described above is unknown at the time the initial notice is filed, it should be indicated on the notice and revised if and when the information becomes known.

HHSC does not authorize any negotiation of the medical expenditures without prior written notification by the State or its designee.

For more information, call the TMHP Third Party Liability Contact Center at 1-800-846-7307 Option 3.

Description  Form
To authorize TMHP to release claim information, Medicaid clients must sign this form. HHSC Authorization for Use and Release of Health Information Form
To authorize TMHP to release claim information, CSHCN Services Program clients must sign this form. Department of State Health Services Form to Release CSHCN Services Program Claims History
Tort referral should be submitted to TMHP on this form. Tort Response Form

 
   
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