Identifying Third Party Liability on Your Medicaid Members

There are many ways during Medicaid enrollment and claims processing to identify if a member has primary coverage. The discovery of other health information occurs in three points; during the application process, prospectively when claims are processed, and post-payment (Pay & Chase). By simply deploying just one of these tactics, states will meet their TPL compliance responsibility under federal law. However, employing only one of these tactics will not enable states to maximize cost avoidance and mitigate the need for “Pay & Chase” recovery work. The savviest TPL programs implement an array of methodologies at all three process points.