Medicaid TPL/Carrier Code

Medicaid TPL/Carrier Code

Send TPL/Carrier Code on Medicaid Secondary Claims


Overview

TPL: Third Party Liability; Some Payers refer to this as a Carrier Code, not to be confused with CFI


State Medicaids may require the TPL/Carrier in different places in ANSI Loop 2330B and can be different for each Payer address.

  • Use the TPL ANSI Field Group to add the TPL/Carrier Code.
  • This will need to be added on the Modify Charge screen on each Claim.
  • It will output in Loop 2330B, REF segment or 2330B, NM109 segment depending on the State Medicaid.
  • Use a Cross Code (contact support for setup)
  • This is set up on the Primary Payer and is only done once.
  • Depending on the State, the System will put the TPL in the Segment where it belongs. (2330B Loop, NM109 segment or 2330B Loop, REF segment)


ANSI Field Groups

  • Example 1: Illinois Medicaid requires the TPL in Loop 2330B in the REF02 segment with a 2U Identifier.
  • Use the ANSI Field Groups to populate the TPL with the 2U Identifier on the MCDIL Secondary Claims.

  • Example 2: Massachusetts Medicaid requires the TPL in Loop 2330B NM109 segment.  This replaces the Payer ID on MCDMA Secondary Claims.


Payers: TPL/Carrier Code Required in Loop 2330B REF Segment with 2U Identifier

  • Illinois Medicaid
  • Arizona Medicaid
  • SC Medicaid


Payers: TPL/Carrier Code required in Loop 2330B NM109

  • Massachusetts
  • Vermont 


ANSI Field Groups

  1.  On the Encounter Dashboard, select the Modify button.

  1. Using the Lookup icon, select TPL.

  1. ANSI Field Group pop-up:
  • Enter TPL code in boxes 37A and 38A.
  1. Select Save [F2].

If you don't need box 38A, select the Keys icon to set the field to Not Mandatory. 

  1. Select Save [F2] on the Modify Charge screen.


Send Additional Information

  1.  From Charges on the Left Side Menu, select the Post Charge button.

  1. Select TPL in the ANSI field. Learn More: Illinois Medicaid TPL Code
  • 37A: TPL Code
  • 37B: TPL Status
  • 37C: TPL Amount
  • 37D: TPL Date
  • 38A thru 38D are the same as above for additional TPL information.
  1. The TPL information displays on the paper (HCFA) Claim and on the Electronic Claim in ANSI Loop 2330B.


TPL/Carrier Code Logic

If Payer ID = MCDIL, and the ANSI Fields TPL is used, add this value to 2330B REF2U

If Payer ID does not equal = MCDIL (such as MCDMA, 2488)
  1. If ANSI Fields TPL is used, add it to 2330B NM109 (replace the payer ID)
  2. If the Cross Code is used, and the TPL is not used, add to 2330B NM109.

Alert
For Internal Use Only: 2330B NM109



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