Reminder: Medicaid Third Party Liability Provider Requirements

Date: 11/13/24

Superior HealthPlan would like to inform providers that the Texas Health and Human Services Commission (HHSC), Office of Inspector General-Third Party Recoveries (OIG-TPR) division has recently seen a high number of escalations due to a Medicaid provider refusing to see Medicaid (STAR, STAR+PLUS, STAR Health, STAR Kids) and CHIP members due to having other health insurance.

Providers who participate in Texas Medicaid may not refuse services to eligible members due to having other health insurance coverage. Additionally, providers are reminded that Medicaid-eligible members cannot be held responsible for charges exceeding a Third Party Liability (TPL) payment for services covered by Texas Medicaid. If the TPL pays less than the Medicaid managed care amount, providers should submit a claim to the Texas Medicaid Managed Care Organization for any additional allowable reimbursement.

For additional information, please see the Texas Medicaid Provider Procedures Manual, SECTION 8.3: THIRD PARTY LIABILITY (TPL), TPR Sources.