Third Party Recovery (TPR) definition
Third Party Recovery (TPR) means the recovery of payments on behalf of a Member by HHSC or the HMO from an individual or entity with the legal responsibility to pay for the Covered Services. TP 13 means Type Program 13, which is a Medicaid program eligibility type assigned to persons determined eligible for federal SSI assistance by the Social Security Administration (SSA). If a subsequent eligibility system uses a different identifier for this eligibility type, references to TP 13 include the subsequent identifier. TP 40 means Type Program 40, which is a Medicaid program eligibility type assigned to pregnant women under 185% of the federal poverty level (FPL). If a subsequent eligibility system uses a different identifier for this eligibility type, references to TP 40 include the subsequent identifier. TP 45 means Type Program 45, which is a Medicaid program eligibility code assigned to newborns (under 12 months of age) who are born to mothers who are Medicaid eligible at the time of the child’s birth. If a subsequent eligibility system uses a different identifier for this eligibility type, references to TP 40 include the subsequent identifier.
Third Party Recovery (TPR) means the recovery of payments on behalf of a Member by HHSC or the HMO from an individual or entity with the legal responsibility to pay for the Covered Services. TP 40 means Type Program 40, which is a Medicaid program eligibility type assigned to pregnant women under 185% of the federal poverty level (FPL). TP 45 means Type Program 45, which is a Medicaid program eligibility code assigned to newborns (under 12 months of age) who are born to mothers who are Medicaid eligible at the time of the child’s birth. Transition Phase includes all activities the HMO is required to perform between the Contract Effective Date and the Operational Start Date for a Service Area. Turnover Phase includes all activities the HMO is required to perform in order to close out the Contract and/or transition Contract activities and operations for a Service Area to HHSC or a subsequent contractor.
Third Party Recovery (TPR) means the recovery of payments on behalf of a Member by HHSC or the MCO from an individual or entity with the legal responsibility to pay for the Covered Services. TJC (formerly JCAHO) means The Joint Commission.
Examples of Third Party Recovery (TPR) in a sentence
The file contains any Third Party Recovery (TPR) data that HHSC's claims administration agent has on file for individual Medicaid clients, organized by name and client number, and adding additional relevant information where available, such as the insured's name/contact information, type of coverage, the insurance carrier, and the effective dates.
CHIP HMOs are authorized to engage in Third Party Recovery (TPR) actions for claims resulting from the care and/or treatment of CHIP Members.
CHIP Perinatal HMOs are authorized to engage in Third Party Recovery (TPR) actions for claims resulting from the care and/or treatment of CHIP Perinatal Program Members.
If CONTRACTOR chooses to engage in Third Party Recovery (TPR) activities, it must file quarterly TPR Reports in accordance with the format developed by the State.
HMO must file quarterly Third Party Recovery (TPR) Reports in accordance with the format developed by TDH.
More Definitions of Third Party Recovery (TPR)
Third Party Recovery (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency, TDMHMR, and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate (see definition of Clean Claim).
Third Party Recovery (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency, TDMHMR, and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate (see definition of Clean Claim). Urgent behavioral health situations means conditions which require attention and assessment within 24 hours but which do not place the Member in immediate danger to themselves or others and the Member is able to cooperate with treatment. Urgent condition means a health condition, including an urgent behavioral health situation, which is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that his or her condition requires medical treatment evaluation or treatment within 24 hours by the Member's PCP or PCP designee to prevent serious deterioration of the Member's condition or health.
Third Party Recovery (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency, TDMHMR, and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate. (See definition of Clean Claim.) Urgent behavioral health situations means conditions which require attention and assessment within 24 hours but which do not place the Member in immediate danger to themselves or others and the Member is able to cooperate with treatment.
Third Party Recovery (TPR) means the recovery of payments on behalf of a Member by HHSC or the HMO from an individual or entity with the legal responsibility to pay for the Covered Services. TP 40 means Type Program 40, which is a Medicaid program eligibility type assigned to pregnant women under 185% of the federal poverty level (FPL). TP 45 means Type Program 45, which is a Medicaid program eligibility code assigned to newborns (under 12 months of age) who are born to mothers who are Medicaid eligible at the time of the child’s birth.
Third Party Recovery (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. TP40 (Type Program 40) means Pregnant women receiving Medical Assistance Only (MOA)-Pregnant women whose families' income is below 185% of the Federal Poverty Level (FPL) TP45 (Type Program 45) means Newborn (MAO) - Children under age one born to Medicaid-eligible mothers. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency, TDMHMR, and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate. (See definition of Clean Claim.) Urgent behavioral health situations means conditions which require attention and assessment within 24 hours but which do not place the Member in immediate danger to themselves or others and the Member is able to cooperate with treatment.
Third Party Recovery (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. THSteps means Texas Health Steps. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency TDMHMR and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate (see definition of Clean Claim). Urgent behavioral health situations means conditions which require attention and assessment within 24 hours but which do not place the Member in immediate danger to themselves or others, and the Member is able to cooperate with treatment. Urgent condition means a health condition, including an urgent behavioral health situation, which is not an emergency but is severe or painful enough to cause a prudent layperson possessing an average knowledge of medicine to believe that his or her condition required medical treatment- El Paso Service Area HMO Contract evaluation or treatment within 24 hours by the Member's PCP or PCP designee to prevent serious deterioration of the Member's condition or health. Value-added services means services which were not included in the RFA as mandatory covered services but which were submitted by HMO with or subsequent to its response to the RFA and which have been approved by TDH to be included in this contract as value-added services in Appendix C - Scope of Services. These services must be provided to all mandatory Members as part of the covered services under this contract. No additional capitation will be paid for these services, under the current capitation rate.
Third Party Recovery (TPR) means the recovery of payments on behalf of a Dental Member by HHSC or the Dental Contractor from an individual or entity with the legal responsibility to pay for the Medically Necessary Covered Dental Services.