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Third Party Resources - Medical

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It is the provider’s responsibility to identify and report other insurance coverage for Texas Medicaid clients, and this information must be included on claim submissions. 
Visit the Third Party Liability (TPL) section of the Texas Medicaid Provider Procedures Manual (TMPPM) to find information about the following:

•    Sources of third party resources (TPR)
•    Identifying a client’s TPR
•    Filing claims when a client has other insurance
•    Refunds from other insurance payments

Providers that participate in Texas Medicaid may not refuse to serve an eligible client because of a third party’s potential liability for payment of the services.  

Updating Policy Information

Keeping clients’ insurance policy information up to date ensures accurate coverage and smooth claims processing. Policyholders, clients or their authorized representatives, and providers should update coverage information when it changes.

How to Update Policy Information:
•    Call TMHP Third Party Liability at 800-846-7307.
•    Complete and submit an Other Insurance Form.

When to Update:
•    A new policy or coverage comes into effect.
•    An existing policy or coverage has been updated.
•    A policy or coverage has been terminated.

Information Needed to Perform a TPR Update:    
•    Policyholder name, if available (first, last)  
•    Insurance carrier name  
•    Processor Control Number (PCN)
•    Group ID number
•    Policy subscriber ID
•    Type of coverage 
•    Effective date
•    Termination date 

For managed care organization (MCO) clients, the TPR team will update information on other insurance, and we encourage clients to speak with their designated MCO to assist with access to care or billing inquiries.