If a member has Third-Party Liability (TPL) coverage that is not listed in the Provider Web Portal, that information can be added by completing the required fields and clicking "Add."
TPL information that already exists in the Provider Portal can be updated. A provider may update the "Policy ID" and "Effective To" date. Enter the new "Policy ID" and/or "Effective To" date and click "Save".
The information submitted will be reviewed by the fiscal agent and will be entered on the member's record in interChange.
Refer to the Submitting a Claim with Other Insurance or Medicare Crossover Information Quick Guide for details on full claim submission when TPL is present.
- Verify Member Eligibility
Prior to adding new or updating existing TPL information, verify member eligibility. Navigate to Eligibility >, Eligibility Verification. After performing an Eligibility Verification for a member, select the Other Insurance Detail Information link at the bottom of the page.
- Adding TPL Information
On the Other Insurance Details page, any existing TPL information for the member will display at the top of the page under "Other Insurance Information for Member ID".
New TPL information is entered at the bottom of the page under "Other Insurance Carrier Information" and "Other Policy Holder Information".
Under "Other Insurance Carrier Information", the "Carrier" field is a predictive search field. Begin typing the name of an insurance carrier to see matching values. The "Coverage Type" is a required field in order to successfully add TPL. Providers may select any coverage type from the dropdown list or use "Inpatient" as their default selection. If the first and last name of the policy holder is unknown, the provider may default to the member's first and last name.
Once the required TPL information has been added under "Other Insurance Carrier Information" and "Other Policy Holder Information", click the "Add" button.
A pop-up will appear when the changes have been accepted.
The newly-added record is visible in the grid.
If additional changes need to be made, click the "+" sign. Make the change and click "Save".
In the example below, the member has more than one TPL coverage. This is common and acceptable. Health First Colorado (Colorado's Medicaid program) is the payor of last resort.
- Updating Existing TPL Information
Verify Member Eligibility (See Step 1). On the Other Insurance Details page, any existing TPL information for the member will display at the top of the page under "Other Insurance Information for Member ID". Click the "+" sign to the left of the TPL resource to edit the existing TPL information.
Only the "Policy ID" and "Effective To" fields can be updated on an existing TPL resource.
Click "Save" after making the updates.
The updated "Policy ID" and/or "Effective To" date will reflect in the grid after review and processing by the fiscal agent.
- Confirming TPL Information Update
The additional TPL information is sent to the fiscal agent for review and processing once "Add" or "Save" is clicked. Once the information is submitted and the provider navigates away from the Other Insurance Details page, the new TPL changes will not be visible when navigating back to the Other Insurance Details page.
Once the new content is reviewed and added to interChange by the fiscal agent, it will display on the Other Insurance Details page in the Provider Portal.
Need More Help?
Please visit the Quick Guides web page to find all the Provider Web Portal Quick Guides.