Common use of Third Party Liability (TPL) Clause in Contracts

Third Party Liability (TPL). The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims. Trauma-informed Care: An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. Urgent care/service needs: Services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services are often but not always those that if not fulfilled could result in an emergency room visit or inpatient admission. Validation: Per 42 CFR §438.320, the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. Voluntary: Refers to situations where the Department cannot or does not require Medicaid members to enroll in a PIHP. Waste: The unnecessary incurrence of costs as a result of inefficient or inaccurate practices, systems or controls. Wisconsin Statewide Health Information Network (WISHIN): Wisconsin’s health information network that shares electronic health information securely between participating physicians, clinics, hospitals, pharmacies, clinical laboratories, Health Maintenance Organizations (HMOs), and Prepaid Inpatient Health Plans (PIHPs) across the state. Wisconsin Tribal Health Directors Association (WTHDA): The coalition of all Wisconsin American Indian Tribal Health Departments.

Third Party Liability (TPL). The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims. Trauma-informed Care: An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. Urgent care/service needs: Services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services are often but not always those that if not fulfilled could result in an emergency room visit or inpatient admission. Validation: Per 42 CFR §438.320, the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. Voluntary: Refers to situations where the Department cannot or does not require Medicaid members to enroll in a PIHP. Waste: The unnecessary incurrence of costs as a result of inefficient or inaccurate practices, systems or controls. Wisconsin Statewide Health Information Network (WISHIN): Wisconsin’s health information network that shares electronic health information securely between participating physicians, clinics, hospitals, pharmacies, clinical laboratories, and Health Maintenance Organizations (HMOs), and Prepaid Inpatient Health Plans (PIHPs) across the state. Wisconsin Tribal Health Directors Association (WTHDA): The coalition of all Wisconsin American Indian Tribal Health Departments.

Third Party Liability (TPL). The legal obligation of a third party (other than Medicaid) to pay for part or all of a claim. Since Medicaid is legally the “payer of last resort,” the identification of other payer obligations is a major requirement in the adjudication of claims. Trauma-informed Care: An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. Urgent care/service needs: Services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services are often but not always those that if not fulfilled could result in an emergency room visit or inpatient admission. Validation: Per 42 CFR §438.320, the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. Voluntary: Refers to situations where the Department cannot or does not require Medicaid members to enroll in a PIHP. Waste: The unnecessary incurrence of costs as a result of inefficient or inaccurate practices, systems or controls. Wisconsin Statewide Health Information Network (WISHIN): Wisconsin’s health information network that shares electronic health information securely between participating physicians, clinics, hospitals, pharmacies, clinical laboratories, and Health Maintenance Organizations (HMOs), and Prepaid Inpatient Health Plans (PIHPs) across the state. Wisconsin Tribal Health Directors Association (WTHDA): The coalition of all Wisconsin American Indian Tribal Health Departments.. Acronym Meaning