Report Third Party Liability (TPL)

Health Plans (HPs) are required by AHCCCS contract to submit new additions and updates to existing Commercial Third Party insurance coverage information associated with their enrolled Medicaid Members. This TPL information is processed, verified and stored in the AHCCCS PMMIS database. It is used to cost avoid medical, dental and pharmacy expense where AHCCCS members have other insurance coverage that must be exhausted prior to using Medicaid funds.

TPL coverage addition, change and termination information is provided through either of two coverage notification processes. Both have the same data requirements for an acceptable transaction.

The website provided by the AHCCCS TPL Contractor

An online Medical Insurance Referral may be completed and submitted to AHCCCS through the Health Management Systems (HMS) website whenever an AHCCCS recipient is discovered to have other medical insurance, or whenever other medical insurance has terminated or changed. The Contractor then verifies the TPL coverage information provided and submits verified records back to AHCCCS.

To gain access to the HMS portal, please contact Kathryn Hart toll free at (888) 378-2836 to create a user account. https://ecenter.hmsy.com/

The Third Party Leads file submission file process

The Third Party Leads File submission process is accomplished by Health Plans depositing a prescribed TLP Lead File on the AHCCCS communications server- SFTP. (See file layout below) The file records will be edited and records with invalid syntax or missing required fields will be rejected.

Filename protocol - yymmdd.tpl

File Location - placed in the Health Plan's folder under AZ/*** /PROD/IN

(Where *** = HP mnemonic)

The files may be placed on the server at any time and are picked up in a nightly sweep for incoming “.tpl” files with that days processing date. It is recommended that Plans place their files for that day on the server no later than 6 p.m. to insure that they proceed that days sweep run. Plans may deposit multiple files with the same date. Advance dated files will be picked up on that processing date. However, prior dated files will never be picked up. If the sweep fails to pick up the file, it must be renamed for the next full days processing.