Public Notice of Final Action for Third Party Liability (TPL) Health Recovery CyclePublic Notice of Final Action for Third Party Liability (TPL) Health Recovery Cycle
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the TPL Health Recovery Cycle under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Section 1902(a)(25)(A) of the Social Security Act requires healthcare providers to bill any beneficiary's primary insurance, if available, prior to seeking Medicaid reimbursement for a covered service. SCDHHS engages in activities to determine if this requirement has been met and recovers funds on a periodic basis either directly from liable third-party insurers or institutional healthcare providers.
Currently, each periodic health recovery cycle begins quarterly and may take up to six months to complete. SCDHHS has observed that nearly 16% of recovery claims are rejected by the financially liable insurer for untimely filing. This is due in-part to the length and infrequent commencement of each cycle.
Effective on or after July 1, 2018, SCDHHS will amend the South Carolina Title XIX State Plan to modify the frequency of the TPL Health Recovery Cycle. The modification will increase the occurrence of the TPL health recovery cycle to afford providers quicker notification of other primary health insurance information. Prompt notification should improve the rate of timely claims filing and allow SCDHHS to recover professional claims from third-party payers in a more timely manner.
Although this action will not increase the total amount of funds SCDHHS seeks to recover, the agency anticipates improvements in the amount and timeliness of recovery of those funds.
Copies of this notice are available at each County Department of Health and Human Services Office and at www.scdhhs.gov for public review. Additional information regarding this action is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at the SCDHHS, Eligibility and Third Party Liability Contract Services, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.