SI DAL01730.045 Third Party Liability for Medicaid Eligibility

A. Policy

When an allowed SSI applicant or recipient has a third party source to cover medical expenses, SSA district offices (DOs) should obtain complete third party liability (TPL) information for residents of Arkansas, Louisiana, New Mexico and Texas.

TPL information is an important tool used by State agencies to reduce Federal and State Medicaid expenditures. States pay SSA to collect TPL information. To effectively use this tool, States must receive complete TPL information from SSA (e.g., policy number, name and address of insurance company, effective date of coverage, etc.).

B. Procedures

For MSSICS initial claims, complete the BTPL screen. Also complete the BTPL screen for redeterminations when there is a change in TPL coverage, or other posteligibility changes as described in SI 01730.045C.5. The TPL information will be electronically transmitted to the State Medicaid agency.

However, there are situations when a paper SSA-8019 must be completed and mailed to the State TPL agency. These situations include:

  • Non-MSSICS initial claims that are allowed;

  • Non-MSSICS redetermination or post-eligibility action with changes in TPL circumstances; or

  • MSSICS claims when complete TPL information was not available at the time the claim was adjudicated (SI 01730.045D.2.).

Mail the fully-completed paper SSA-8019-U2 on a weekly basis to the appropriate TPL State agency using the address below:

Arkansas

Department of Human Services
TPL Unit - Slot S296

P. O. Box 1437

Little Rock, Arkansas 72203

Louisiana

Department of Health and Hospitals

BHSF TPL/Medicaid Recovery Unit

P. O. Box 91030

Baton Rouge, Louisiana 70821-9030

New Mexico

Medical Assistance Division
TPL Unit

P. O. Box 2348

Santa Fe, New Mexico 87504-2348

Oklahoma

Oklahoma is not a Section 1634 State. SSA does not obtain TPL information for Oklahoma residents.

Texas

Health and Human Services Commission
Office of Investigation and Enforcement

Third Party Resources

P.O. Box 13247

Austin, Texas 78711-3247


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501730045DAL
SI DAL01730.045 - Third Party Liability for Medicaid Eligibility - 05/15/2008
Batch run: 01/27/2009
Rev:05/15/2008