Medicaid Third Party Liability Discrepancies

It’s a challenge for Medicaid HMOs and MCOs to keep up to date with a member’s third party liability (TPL) when their enrollment is no longer current. Here’s what you can do:

• Validate TPL coverage with the member for each service provided.

Compare the member’s TPL against the ForwardHealth Portal.  If there is a discrepancy validated with the member’s TPL, report the discrepancy on the ForwardHealth Portal.  TPL additions and terminations are updated in real time. Deletions are researched before updating the record. For instructions, download the ForwardHealth Portal Other Coverage Discrepancy Report User Guide.