Learning Resources
Third-Party Liability (Visual Book)
Third Party Liability: The Visual Medicaid Basics Book
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Contents:
Payer of last Resort • Cost Avoidance • Check Eligibility • TPL Coverage Sources
Sequential Billing • Dually Eligible Sequence • Health Insurance Information Referral Form (HIIRF)
Research of Documentation • Required TPL Claim Information • Carrier Codes • Policy Numbers
Required CMS-1500 TPL Claim Information • UB-04 TPL Claim Information • Reporting TPL on the Web Tool
How to Calculate TPL Payments • Professional Claim Example • CMS-1500 Calculation Examples
UB-04 Medicare Claims Calculation • UB-04 Calculation Examples • Timely Filing • TPL Edits
Edit Code Description and Resolution • UB04 ECF Example • Reasonable Effort
Reasonable Effort Documentation Form • Retroactive Recovery • Pay and Chase • Voluntary Refunds
Refunding by Check • Refund by Void/Replacement • Solicited Refunds • Retroactive Recovery Letters
Retro Medicare Provider Letter • Retro Health Initial Letter • Retro Health Final Letter • SCDHHS and TPL