Policy History for 6.3.8 TPL END DATE

Release 06-01

 

6.3.8 TPL END DATE

Each month EDS sends a Third Party Liability ( TPL ) Segment – End Date Report to all certifying agencies (6.3.11).  The report lists cases that have an insurance end date that has been applied in the last month.  

 

If EDS verifies a major medical policy has ended, EDS automatically updates CARES Client Assistance for Re-employment & Economic Support and sends an alert.  The worker should:

 

  1. Ask the client if the insurance has ended.
     

  2. If the client says that the insurance listed has not ended, the information is considered questionable.  Verify the insurance information and update CARES ( AFMC and AFMI ).
     

  3. Run eligibility.

 

The information on the End Date Report is arranged in eight columns under the following numbers:

 

  1. Name of the casehead.

  2. Name of the insured person.

  3. Insured person’s MA ID number.

  4. Name of the insurance policy holder.

  5. Policy number.  The name of the insurance carrier appears under the policy number.

  6. The date on which coverage with the carrier named in #5 ended.

  7. Who submitted the end date?  If “INS CO” is listed, the insurance carrier provided the end date.  If “AGENCY” is listed, the ESA or CSA provided the end date.

  8. Indicates whether the person named in #2 has another insurance policy that is still in effect.
     

If the open insurance policy (indicated in #8) is a drug or dental plan that was part of the terminated policy, it must also be ended.  

 

When a TPL Segment ends, EDS allows medical bills that would have gone first to an insurance company to be reviewed immediately by MA for payment.

 

This page last updated in Release Number : 02-04

Release Date: 10/01/02

Effective Date: 10/01/02