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TMSIS Dataguide Medicaid.gov
Version 3.27.0

TPL - THIRD-PARTY LIABILITY

File

File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
TPL00001 FILE-HEADER-RECORD-TPL A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
TPL00002 TPL-MEDICAID-ELIGIBLE-PERSON-MAIN A record to capture basic, generally static information to identify Medicaid/CHIP enrollees for whom third party funds may be available to offset some or all of their Medicaid/CHIP costs.
TPL00003 TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO A record to capture insurance policy information needed to facilitate pursuit of the third party liability.
TPL00004 TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES A record to capture TPL insurance coverage information to support the applicability assessment of the third party insurance coverage to the Medicaid/CHIP costs incurred on behalf of the Medicaid/CHIP enrollee.
TPL00005 TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION A record to flag Medicaid/CHIP enrollees who potentially have non-insurance sources of funds that could be used to offset Medicaid/CHIP expenditures.
TPL00006 TPL-ENTITY-CONTACT-INFORMATION A record to capture addresses and phone numbers of the entity providing TPL insurance coverage.
Definition
New file of beneficiary level third-party liability (TPL) data and insurance carrier level data.

Overview

Diagram 8: Third-Party Liability (TPL) File – TPL Record Segment Relationships

tpl_overview

Description of Diagram 8:

Each instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are actually two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.

TPL Health Insurance Entity Subject Area

Two types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:

1. SUBMITTING-STATE
2. INSURANCE-CARRIER-ID-NUM

Medicaid/CHIP Enrollees with TPL Funding Subject Area

Three types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:

1. SUBMITTING-STATE
2. MSIS-IDENTIFICATION-NUM