Third Party Liability & Coordination of Benefits

Date: 06/14/17

Third Party Liability (TPL) is when the financial responsibility for all or part of a participant's health care expense rests with an individual entity or program other than the CHC managed care organization (CHC MCO), such as Medicare or commercial insurance.

Providers are required to check the Eligibility Verification System (EVS) to ensure a participant is eligible for services prior to rendering services. EVS will include information of the participant’s MCO along with any TPL information. At the date of service, providers should always ask participants for all forms of insurance, not just their CHC Medicaid insurance card or ACCESS card. This is to ensure that benefits are properly coordinated and that Medicaid (CHC MCO) remains the payer of last resort. Read More...