Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
Third Party Liability Reminder – Medicaid Managed Care Provider Requirements
Date: November 27, 2024
Attention: All Providers
Background information: The Texas Health and Human Services Commission (HHSC), Office of Inspector General-Third Party Recoveries division (OIG-TPR) has recently seen a high number of escalations due to a Medicaid provider refusing to see a Medicaid Member because the Medicaid Member has other health insurance.
Providers who participate in Texas Medicaid may not refuse services to eligible Medicaid Members due to potential other health insurance coverage. Additionally, providers are reminded that Medicaid-eligible Members cannot be held responsible for charges exceeding a third-party liability (TPL) payment for services covered by Texas Medicaid. If the TPL pays less than the Medicaid managed care amount, providers should submit a claim to Texas Children’s Health Plan (TCHP) for any additional allowable reimbursement.
TCHP would like to remind providers that they cannot refuse services to an eligible Medicaid Member because the Medicaid Member may have other health insurance coverage, and the Medicaid Member cannot be held responsible for charges exceeding a TPL payment for services covered by Texas Medicaid.
