Medicaid THIRD PARTY LIABILITY (TPL) - During eligibility

When checking eligibility, sometimes, there is COMMERCIAL INSURANCE listed on the Medicaid website as primary payer. After checking the primary payer websites, I find that the commercial insurance has terminated - sometimes up to 8 months prior. What can I tell parents to do to get the commercial insurance removed, so that we can utilize their Medicaid coverage? Who do they need to contact? Who can they call? If you can please help us with this, it would be very much appreciated.

If a recipient has other insurance coverage through a third party source, such as Medicare, TRICARE, insurance plans, AARP plans, or automobile coverage, we refer to that as Third Party Liability (TPL). As you know, these other sources must be billed prior to billing Medicaid. Florida Medicaid currently contracts with Affiliated Computer Systems (ACS) to manage TPL operations. Providers who have questions or problems concerning third party insurance can contact the Medicaid third party contractor:

*  By telephone at 877-357-3268 (FL-RECOV),

*  By fax at 866- 443- 5559,

*  Through the website at http://www.FLMedicaidTPLRecovery.com,

*  By e-mail at FLMedicaidTPLRecovery@acs-inc.com,

*  Or in writing to:

ACS; Florida TPL Recovery Unit; 230; Killearn Center Blvd., Bldg A1; Tallahassee, Florida 32309

The TPL contractor can make the necessary corrections to the information on the recipients’ files.

How do we handle patients with FULL MEDICAID who also have an individual plan (ex. BCBS) and they refuse to acknowledge the individual coverage. BCBS makes it a patient responsibility/deduct and then Medicaid paid for the service. What do I do?

Medicaid is always the payer of last resort. Other insurance, including Medicare, must be billed prior to requesting Medicaid payment. Florida Medicaid currently contracts with Affiliated Computer Systems (ACS) to manage Third Party Liability (TPL) operations. Providers who have problems concerning third party insurance information can contact ACS, and they will make the necessary corrections to the information on the recipients’ files. If the TPL approves the service, but does not make a payment because it is applied to the patient’s deductible the provider can bill to Medicaid with the TPL EOB and is entitled to received payment for the service up to the Medicaid fee.