Systems Help: PS2 Instructions – Section H (Third Party Liability)

Section H is to be completed on all Money Payments, CFH and Medical Services cases where the client has been or is currently covered by health related insurance.

The following are descriptions/ instructions of each Section H (Third Party Liability) field in IMS:

Notebook: INTER
Tab: TPL
Field: Sequence Code.
PS-2 Block: H1
Instructions: Sequence codes are assigned by the worker and are the letters A-Z. In FACS, the code is automatically assigned. A code may be used only once.
Notebook: INTER
Tab: TPL
Field: Policy Number.
PS-2 Block: H4
Instructions: Enter the identifying insurance policy number.
Notebook: INTER
Tab: TPL
Field: Name Code.
PS-2 Block: H7
Instructions: Enter the code in accordance with Appendix M9 to identify the name and address of the insurance company. If code “99900” is used, H25-H29 must be completed. * Note
Notebook: INTER
Tab: TPL
Field: Insurance Code.
PS-2 Block: H10
Instructions: Enter one of the following codes to indicate the type of insurance coverage. If the policy has more than one coverage type and has major medical coverage, use major medical.

  • 1 = Hospital
  • 2 = Hospital / Physician
  • 3 = Major Medical
  • 4 = Accident Only
  • 5 = Prescription Drugs
  • 6 = Medicare Supplement – Part B
  • 7 = Cancer and/or Dreaded Disease
  • 8 = Nursing Care Only
  • 9 = Ambulance
  • 10 = Dental
  • 11 = Hospitalization / Surgical Care
  • 12 = HMO (Health Maintenance Organization)
  • 13 = Managed Health Care (Tulsa Only)
  • 14 = Vision Care
  • 20 = Medicare Supplement – Part A
  • 21 = NTMC
  • 22 = Medicare Supplement – Both Parts A & B
Notebook: INTER
Tab: TPL
Field: Beginning Coverage Date.
PS-2 Block: H13
Instructions: Enter the effective date the insurance coverage began (month, day, and year). Do not update if the policy becomes inactive.
Notebook: INTER
Tab: TPL
Field: Ending Coverage Date.
PS-2 Block: H14
Instructions: Enter the date insurance coverage ended (month, day, and year).
Notebook: INTER
Tab: TPL
Field: Policy Holder
PS-2 Block: H19
Instructions: Enter one of the following codes to identify the insurance policy holder.

  • 1 = Payee in this case
  • 2 = Spouse in this case
  • 3 = Father
  • 4 = Mother
  • 5 = Absent Parent
  • 6 = Step-Parent
  • 9 = Other
Notebook: INTER
Tab: TPL
Field: Policy Holder’s Name
PS-2 Block: H20
Instructions: If the policy holder is not the payee or spouse, enter first and last name of policy holder. If the policy holder is unknown, enter “Unknown”.
Notebook: INTER
Tab: TPL
Field: Policy Holder’s SSN
PS-2 Block: H21
Instructions: If the policy holder is not the payee or spouse, enter the policy holder’s SSN. The computer will enter the policy holder’s SSN for the payee and spouse.
Notebook: INTER
Tab: TPL
Field: Insurance Company Name.
PS-2 Block: H25
Instructions: Enter the name of the Insurance Company, Employer, or the Group Carrier.
Notebook: INTER
Tab: TPL
Field: Mailing Address
PS-2 Block: H26
Instructions: Enter the street address or post office box for the insurance company.
Notebook: INTER
Tab: TPL
Field: Mailing City
PS-2 Block: H27
Instructions: Enter the city of mailing address.
Notebook: INTER
Tab: TPL
Field: Mailing State
PS-2 Block: H28
Instructions: Enter the state code of mailing address.
For example, for Oklahoma, enter OK.
Notebook: INTER
Tab: TPL
Field: Mailing Zip Code
PS-2 Block: H29
Instructions: Enter the zip code of mailing address

NOTE: H25-H29 are completed only if H7, Name Code, was entered as “99900”

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