Third Party Liability (TPL)
The Third Party Liability Unit is responsible for identifying, managing and recovering funds for claims paid for by Florida Medicaid for which a third party was liable, thereby ensuring Medicaid is the payer of last resort. TPL recovery services are contracted with Health Management Systems (HMS), Inc. Some examples of liable third parties include: Medicare and other insurance companies, tort/casualty settlements, recipient estates, and trust and annuity recovery. New or updated third party insurance information is also added to the Florida Medicaid Management Information System (FMMIS) in order to cost avoid claims that are submitted by Medicaid providers. When a provider submits a claim and a recipient has other insurance, the provider is instructed to bill the other insurance company prior to billing Medicaid. In addition, the TPL Unit also works in conjunction with the Agency's Bureau of Medicaid Program Integrity to conduct other Medicaid recoupment projects such as: overpayments, duplicate payments, provider audits, and overutilization.
Notices to Florida Medicaid regarding any third-party benefit, including trust, annuity, or estate probate actions, must be submitted in accordance with sections 409.910, 409.9101, and 733.2121, Florida Statutes (F.S.), to the appropriate address located below.
Florida Medicaid TPL Recovery Program
P.O. Box 12188
Tallahassee, FL 32317-2188
MEDICAID THIRD PARTY LIABILITY (TPL) LIEN/CLAIM REQUESTS: If you are an Attorney representing a Medicaid recipient needing to substantiate Medicaid’s lien relating to a tort or casualty accident/incident or Medicaid’s claim against the estate or against a trust account or annuity pursuant to Sections 409.901, 409.910, 409.9101 and 733.2121(3)(d), Florida Statutes, please click on this website https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/forms/index.html and select HIPAA Compliant Medical Release. NOTE: The Medicaid TPL vendor will only produce paid claim(s) related data. In order to avoid delays due to improper TPL records requests, please only request paid claim(s) data/records.
For additional information about the Florida Medicaid Third Party Liability Recovery Program, please call our vendor at 1-877-357-3268 or visit our website at www.flmedicaidtplrecovery.com.
Assistance for Medicaid Providers inquiring specifically about Explanation of Benefits (EOB) reason codes 9322 and 9332, please call 1-844-785-0637.
To review, Florida Administrative Code 59G-1.052 Third-Party Liability Requirements, please visit https://ahca.myflorida.com/medicaid/rules/adopted-rules-general-policies.
Please visit http://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_TPL/tabId/45/Default.aspx to find Florida Medicaid’s TPL Carriers Listing. The listing is furnished to use when Medicaid recipients have other insurance that should process a claim before Medicaid processes the claim.
