Third party updating
For training presentations and detailed information about COB/TPL policies, see our Coordination of Benefits and Third Party Liability (COB/TPL) in Medicaid 2016.
Coordination of Benefits (COB) refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through an individual, entity, insurance, or program that is liable to pay for health care services.
The Deficit Reduction Act of 2005 included several additional provisions related to TPL and coordination of benefits for Medicaid beneficiaries.
For more information on Medicaid TPL and COB, see our Frequently Asked Questions.
Examples of third parties which may be liable to pay for services: States gather information regarding potentially liable third parties, including information about other sources of health coverage, when individuals apply for medical assistance.Third parties may request verification from the State Medicaid agency that the contractor is working on behalf of the agency and the scope of the delegated work.The contract language between the State Medicaid agency and the Managed Care Organization (MCO) dictates the terms and conditions under which the MCO assumes TPL responsibility.State Medicaid programs may contract with MCOs to provide health care to Medicaid beneficiaries, and may delegate responsibility and authority to the MCOs to perform third party discovery and recovery activities.The Medicaid program may authorize the MCO to use a contractor to complete these activities.
This feature was first released in the Config Mgr Technical Preview version 1806, however this blog post covers the Current Branch release of Config Mgr.