Third Party Liability
DPHHS is required to take all reasonable measures to ascertain the legal liability of “third parties” for health care items and services provided to Medicaid beneficiaries. “Third parties” include but are not limited to: health insurance carriers, self-insured plans, pharmacy benefit managers and other parties that are legally responsible for payment of a claim for a health care item or service, such as workers’ compensation, auto insurance and liability insurance plans.
Third Party Liability (TPL) staff manages the following:
Casualty Recovery: Medicaid recipients injured through the acts or omissions of another party can sue the other party for damages, even though Medicaid paid the medical bills associated with the injury. Section 53-2-612, MCA, grants DPHHS a lien on any third party payment received by a Medicaid recipient to reimburse the recipient for injuries for which Medicaid has paid medical expenses.
Collection of Benefit Over-Issuance: TPL staff seeks recovery of Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF) and Medicaid benefits improperly paid to individuals.
Estate Recovery: Federal regulations require the TPL program to recover Medicaid payments made on behalf of certain Medicaid recipients after the recipient’s death.
Health Insurance Premium Payment (HIPP): DPHHS may pay premiums of an individual or group health plan as long as it has determined that payment of the premiums is cost effective.
Medicare Buy-in: DPHHS can use Medicaid funds to pay the premiums for Medicaid recipients participating in the Medicare program.
For more information about TPL
Third Party Liability Supervisor