Close a TPL Policy

Key Points:

When closing a TPL policy, it is important that the actual date the policy terminated is entered. The Providers are still filing older claims and Medicaid is still trying to get reimbursement on older dates. The TPL end date could affect the TPL reimbursement to Medicaid if it is entered incorrectly. If you are unsure of the actual termination date, the closest reasonable date may be entered. A "C" letter questionnaire may also be initiated to send a request to the carrier for the actual coverage dates.

To Close the Policy:

  1. Logon to C1 and select Function 2 – ‘Medicaid Third Party Liability’. Click on ENTER.
  2. Select Function 1, ‘Health Insurance/Medical Liability’ from TPL Subsystem Menu. Click on ENTER.
  3. From the Case Activity Screen, enter ‘S’ (for Search) under the Action Code. Directly under ‘Action Code’, enter the Master Case Number. Press ENTER (the SSN, Medicaid number and other fields on this window do not need to have data entered).
  4. The Search Reply screen will display all persons in the Master Case. Any insurance information that was previously entered will appear under their name. Enter an ‘X’ under the heading ‘ACT’ for the policy that needs to be end dated. If there are multiple persons with the same policy, you can select the policy under each person’s name. Select the enter key to return to the Case Activity Screen.
  5. In the Action Code on the Case Activity Screen, change the ‘S’ to ‘C’ (for Change) and select enter
  6. On the policy information, change the Info Source to 01 (for caseworker), then tab to the coverage TO DATE and type in the end date of the coverage. If you wish to generate a form to verify the exact end date, in the Verif field, enter a “C”. This will generate a form to the insurance company.  Tthe TPL unit will update the termination date of the policy, if necessary, when the verification letter is returned from the insurance company.

Note: Use the F1 key on your keyboard for HELP for a specific field.  Place the cursor in the field for which you need help, and press the F1 key on your keyboard.

(03-2009)