The Third Party Liability Unit (TPL) is responsible for ensuring that the Medicaid program is the payer of last resort. As Medicaid costs go up, it’s important to hold third party payers, such as private carriers, Medicare, and the Veterans Administration, responsible before Medicaid provides assistance.
The TPL’s main functions include:
- Insurance Verification: The TPL verifies other insurance using data matches, reviews of claims, referrals from providers, insurance carriers, recipients, and DHHS case technicians. Once other insurance is verified, TPL is responsible for billing and monitoring payment.
- Accident and Trauma: The TPL conducts reviews of accident and trauma when Medicaid recipients are injured in a car or work place accident, or other incident such as a fall, that their liability insurance covers. TPL staff review diagnosis and procedure codes on billing claims to determine an accident related injury. Staff also use provider referrals, and inquiries from attorneys and recipients to assist in determination. TPL is authorized to seek reimbursement of funds from injury settlements. If a recipient requests information to be released to a third party, such as a lawyer, a HIPAA Access to Records Request must be completed and notarized.
- Insurance Mail Order Co-Pay Reimbursement: NH Medicaid has established a program to reimburse Medicaid recipients for prescription co-pays that their private insurance mail order programs require. NH law does not allow Medicaid to pay for medical services and medications that other insurance covers. However, co-payments may be required for mail order insurance. Recipients can complete the Insurance Mail Order Co-Pay Reimbursement Form to receive payment.
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