Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

Reminder: Third Party Liability Requirements for Medicaid Providers

Last updated on

Texas Medicaid providers are reminded that they cannot refuse services to Medicaid-eligible members due to the members’ possession of other health insurance coverage. For more information, refer to the Texas Medicaid Provider Procedures Manual, Section 8: Third Party Liability (TPL), Subsection 8.3, “TPR Sources.”

Additionally, Medicaid-eligible members cannot be held responsible for charges exceeding a TPL payment for services covered by Texas Medicaid. If the TPL payment is less than the Medicaid-allowable amount, providers should submit a claim to the Texas Medicaid & Healthcare Partnership (TMHP) for the additional allowable reimbursement. For more information, refer to the Texas Medicaid Provider Procedures Manual, Section 8: Third Party Liability (TPL), Subsection 8.2, “Verifying a Client’s TPR.”

For assistance with any further questions, contact the TMHP Third Party Resources Unit at 800-846-7307.