News

Changes to the Third Party Liability (TPL) Billing for Alabama Medicaid

10/16/2012

To:  Providers Submitting Claims with Third Party (TPL) Primary

Effective October 23, 2012, HP will begin capturing Third Party Liability patient responsibility amounts at both header and detail levels. Changes will be made to all claim types except Pharmacy. 

In order for claims with TPL to be considered for payment, the patient responsibility must be greater than zero. Patient responsibility is calculated by adding together any co-payments, co-insurance and deductible. Claims that do not contain a patient responsibility will deny with error status code 631 (TPL Patient Responsibility is Zero for Payor).

When calculating payment methodology for claims with TPL primary, Medicaid will pay the lesser of patient responsibility or Medicaid allowed amount minus TPL paid amount for professional claims only.  All other claim types will continue to price as usual at this time. System changes will be implemented at a later date for the payment methodology of other claim types.

For complete details, click on this link:  http://216.226.177.83/documents/2.0_Newsroom/2.8_ALERTS/2.8_ALERT_TPL_
Billing_Changes_10-16-12.pdf