Third Party Health Insurance

Once TPHI verifies the existence of a coverage, it data-enters the specifics of the insurance into the Medicaid Management Information System (MMIS) where it is used for claims processing. This method insures cost avoidance of Medicaid for all bills that could be covered by a another resource.

In addition to its primary task of uncovering, validating and data-entering health insurance information, TPHI also:

Responds to inquiries from medical providers for Medicaid
and insurance information

Assists clients and providers in the resolution of billing
problems

Determines when it might be cost-effective for the Department
to continue payment of clients' health insurance premiums

Pursues recoveries of expended Medicaid funds in cases
where an insurance resource is found to exist after Medicaid
has paid claims.