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;
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•
Non-MSSICS redetermination or post-eligibility action with changes in TPL circumstances;
or
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•
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:
Colorado
Department of Health Care Policy & Financing
Attn: Third Party Resources
1575 Sherman Street
Denver, Colorado 80203-1714
Montana
Department of Public Health & Human Services
TPL Unit
P. O. Box 202953
Helena, Montana 59620-2953
North Dakota is not a Section 1634 State. SSA does not obtain TPL information for North Dakota
residents.
South Dakota
Department of Social Services
Medicaid Eligibility Administrator
700 Governors Drive
Pierre, South Dakota 57501
Wyoming
Department of Health
Office of Medicaid, Attn: Debbie Paiz
Hathaway Building
Cheyenne, Wyoming 82002
Utah is not a Section 1634 State. SSA does not obtain TPL information for Utah residents.