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Reminder: Third Party Liability Requirements for Medicaid Providers

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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.