Information regarding Third Party Liability (TPL) needs to be coded on the TPL tab in FACS so that the Oklahoma Health Care Authority (OHCA) can make sure the private insurance covers their part before OHCA pays anything on a bill. Make a copy of the insurance card so the information from that card can be entered into FACS. If the card does not show what kind of insurance it is, be sure to clarify with the client.
Medicare Parts A (hospital), B (doctor/therapist) or D (prescription) do not need to be entered into FACS. CMS (Centers for Medicare and Medicaid Services) reports that information to OHCA. Medicare Part C (also known as a Medicare Advantage or Supplement, or Medigap) needs to be entered into TPL.
For additional information regarding coding, refer to article PS2 Instructions – Section H (Third Party Liability).
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