Judy the numbers juggler explains to Simon the robot that:

• TPL claims require the "patient responsibility" amount (field 30 on the CMS-1500 form)
• Edit 165 denies the claim otherwise.
• The patient responsibility is the total of: deductible + coinsurance + copay.
• Medicaid pays the lesser of: patient responsibility or [Medicaid allowed minus the other carrier's paid amount], unless the provider has accepted payment in full.

Listen to this podcast (3 min.) 

Further Links

• Bulletin: "Reporting Patient Liability on CMS-1500/837P Claims" (May 1, 2011)
• The Visual Medicaid Basics Book: Third Party Liability
• Script for this podcast