TX · guidance
Tex. HHSC Medicaid Hospice Provider Manual § 4400
Third-Party Reimbursement
Revision 06-2; Effective December 12, 2006
Hospice providers cannot retain money collected from third-party payers, such as private insurance companies, on behalf of Medicaid recipients. Under terms of the contract between the provider and HHSC, the provider agrees to accept HHSC' vendor rate as payment in full on behalf of Medicaid recipients.
Title XIX of the Social Security Act (42 CFR 433, Subpart D) requires HHSC to use all third-party payment resources before spending Medicaid funds. HHSC also is required to seek reimbursement from liable third parties if Medicaid payments were made before the identification of a third-party payment resource.
When a recipient files an application for Medicaid or receives services from HHSC, the recipient automatically grants the right of financial recovery for the cost of medical care to HHSC. When a recipient is determined eligible for Medicaid, the provider is no longer entitled to receive financial reimbursement for the cost of the recipient's care from any other source. HHSC is to be reimbursed for any insurance payment the provider received on behalf of a Medicaid recipient. State law provides that the filing of an application for, or receipt of, Medicaid benefits constitutes an automatic assignment to HHSC of the applicant's or recipient's right of recovery from personal insurance, other sources or other persons for personal injury caused by the other person's negligence or wrongdoing.
The HHSC Third Party Resource Unit (TPR), Provider Claims Services is responsible for recouping Medicaid expenditures from third-party resources for long term care claims. TMHP is responsible for collecting payments from third-party resources for medical expenditures, such as hospitals, laboratories and physician services.
Notify the HHSC ME staff of information concerning a recipient's third-party resources. Refer questions about third-party resources or insurance reimbursement to the TRP Unit at:
Provider Claims Services
Third Party Resource
Mail Code W-400
P.O. 149030
Austin, TX 78714-9030
Provenance
- Source
- fhb.hhs.texas.gov
- Retrieved
- 2026-10-01
- Edition
- mhpm-2011-05-11
- Content hash
017769604a6dcdcb44172784c28c27c854a3784a39240968878638be17d9d43d
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