TYPES OF WASTE, ABUSE AND FRAUD
Third Party Resources
Return to Types of Waste, Abuse & Fraud
Third Party Resources reduces program cost by shifting claims expense to third party
payers. The Medicaid program is intended to be the payer of last resort; that is,
all other available third party resources must meet their legal obligation to pay
claims before the Medicaid program pays for the care of an eligible individual.
Referrals are made to Third Party Resources when there is suspicion or evidence
that a third party is liable for costs.
The following are examples of third party resources:
- individual health insurance, including assigned indemnity contracts;
- group health insurance, usually through employers;
- public health programs, such as Medicare or CHAMPUS;
- self-insurance plans;
- medical support (usually court ordered) from absent parents;
- automobile insurance, including no-fault insurance;
- workers compensation insurance;
- other casualty insurance, such as business insurance for slip-and-fall injuries;
- tort cases (where the recipient is represented by an attorney in a civil action).
Need to reach the Third Party Resources section directly? For TPR issues call toll
Fax General TPR Inquiries to 512-506-7803 and for Tort/Subrogation
Fax to 512-514-4225.