Skip to main content

Third Party Liability

Third party liability (TPL) under CMS refers to the legal obligation of third parties to pay for medical services provided to beneficiaries under Medicare and Medicaid programs.

Third Party Liability

Last updated on

Third Party Liability (TPL) for Texas Medicaid ensures that Medicaid is the payer of last resort by shifting claim expenses to third party payers.

Third Party Resources

A third party resource (TPR) is an entity, individual, or other source that is legally responsible for paying these claims. 

Federal law requires states to ensure that Medicaid is the payer of last resort. This means that all third parties must meet their legal obligation to pay claims before Medicaid or the CSHCN Services Program can reimburse providers for services they render. As a condition of program eligibility, clients assign their rights to medical support and payment for medical care from any third party to Medicaid and the CSHCN Services Program.

For a comprehensive list of TPR sources and exclusions, refer to “TPR Sources” in the Third Party Liability section of the Texas Medicaid Provider Procedures Manual (TMPPM).

Helpful Links