DATE: APRIL 7, 2003
Manual: Family and Children’s Medicaid
Change No: 17-03
To: County Directors of Social Services
Effective: May 1, 2003 Make the following change(s)
Storing and using Third Party Recovery (TPR) data electronically allows the State to cost avoid millions of dollars in Medicaid claims. The effectiveness of the process relies solely on worker commitment to input and maintain correct TPR data.
Over the years, TPR data has become more complex as there are more medical insurers or types of coverage available in the marketplace. Previous EIS edits did not support these changes. In addition, DMA discovered discrepancies in the Absent Parent Liability Report. Based on all these factors, it was decided to make enhancements to EIS. While the system requirements were being developed and tested, the Absent Parent Liability Report was not sent to the Child Support Enforcement Section. Due to TPR automation changes, the division will again distribute the report to the Child Support Enforcement Section.
MA-3510 is updated to coordinate with changes in EIS. See EIS Change Notice 06-03. The data collection screens for the Third Party Insurance now include a non-custodial parent (NCP) policyholder indicator. The worker must indicate whether the NCP is the policyholder for each individual covered by each insurance policy.
Direction has been given regarding situations where Third Party Coverage exists but the a/r is unable to get information such as name of insurance company, group name/number and policy number. Workers are instructed to contact employers and/or insurance companies.
TRICARE and CHAMPVA web sites and toll free telephone numbers have been added as reference.
End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant) has been added to the Medicare eligible.
May 1, 2003 is the effective date; however, the revised individual TPR screens will be available April 28, 2003.
If you have any questions, please contact your Medicaid Program Representative.
Nina M. Yeager
(This material was researched and written by Beverly Miles, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.