HOME HEALTH: MEDICAID THIRD PARTY LIABILITY (TPL)

Help Desk Question of the Week:

HOME HEALTH MEDICAID THIRD PARTY LIABILITY (TPL)

Listserv Question: Are any other home care providers having issues with Medicaid denying claims with the message “RECIPIENT HAS OTHER INSURANCE COVERAGE ON THE MEDICAID THIRD PARTY LIABILITY FI” on claims that were being paid in the past with “TPL ON RECIPIENT FILE, NOT ON CLAIM (PAY CLAIM)” when entered directly in OHMITS?

This is now an issue for us with patients that have Third-party Liability coverage with Third-party Payers that we had billed in the past, received EOB on the denials, and attached them to claims we then submitted to Medicaid over a year ago. From that point on, the claims would pay with the “TPL ON RECIPIENT FILE [..]” response.

However, around the end of 2019, these claims stopped paying despite the fact there are not any changes in their respective third party coverage. We were given conflicting information (from both Provider Assistance and noninstitutional_policy@medicaid.ohio.gov) that there was a known system error, on the one hand, and that our provider type requires *current* TPL information attached to *every* claim, on the other hand, which was not the case in the past.

Answer from Connie Fox from ACMC Regional Home Health: Have you entered the TPL information on the denied claims into MITS? If not, more than likely that is why you are not getting paid.
Connie sent OCHCH the MEDICAID TPL INSTRUCTIONS she wrote up for her staff on how to enter it into MITS as it is several steps longs. On behalf the OCHCH members – Thank you Connie!!!