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Third Party Liability

Medicaid is the payer of last resort in most circumstances. Medicaid pays for services only after a liable third party has met its legal obligation to pay. The Legal and Finance divisions of the Oklahoma Health Care Authority work together to determine the legal liability of third parties (TPL) to pay for services furnished to Medicaid clients and seek reimbursements for those services.

Federal law and regulations require states to assure that recipients use all other resources available to them to pay for all or part of their medical care needs before turning to Medicaid.

TPL Carriers

Establishing and maintaining effective third party liability programs reduces unnecessary Medicaid expenditures and allows more comprehensive programs to be offered. Third parties include but are not limited to, private health insurance, casualty insurance, worker's compensation, estates, trusts, tort proceeds and Medicare.

The TPL Carriers are the health insurance companies with which OHCA maintains a third party resource/billing relationship. The list includes the OHCA carrier number and carrier billing address. OHCA is responsible for pursuing third party payers for both the fee-for-service and SoonerCare program areas.

Health Insurance Questionnaire

The health insurance and injury/accident questionnaire helps determine whether another source should pay a Medicaid member's medical bill(s). You will need Adobe Acrobat Reader on your computer to view and/or save this questionnaire. The document may be printed off, filled out and returned by fax at 405-530-3478 or by mail to OHCA, 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.

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Last Modified on Jan 19, 2021
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