TPL Pro: Liability Payer Identification System

ProPartners TPL Pro Liability Payer Identification System is a first of its kind system to assist in the identification and collection of third-party liability claims. Federal and commercial health insurers require that claims for injuries resulting from third party liability be paid by the liability carrier. These programs reward hospitals by permitting them to recover charges from the responsible liability carrier, often resulting in reimbursement several times greater than that available from contracted health insurers.

The system works by identifying claims which contain diagnosis codes indicative of a situation where third-party liability may exist. These claims are reassigned to a new claim address and financial class for a hospital defined period of time. Each day, TPL Pro queries either internal or external Release of Information (ROI) systems to determine if records were requested for claims held by TPL Pro. Claims that are found to have a ROI request are reported to a hospital designated individual so that appropriate collection activities can be initiated such as filing the hospital lien on liability carrier proceeds. For claims not found in the ROI database after the hospital defined claim hold period has expired, the original payer information is restored and the claims are sent to the billing system for submission.

Features

Identification of Third-Party Liability Claims
TPL Pro scans claim files to identify those claims with diagnosis indicative of third party liability including auto accident, slip & fall, products liability, and workers compensation.

Statutory Hospital Lien Filing
Assists in the filing of statutory hospital liens on cases where an attorney is pursuing a claim against a third party on behalf of the patient.

HIPAA Compliant
Utilizes the HIPAA standard 837 claim format for processing claims and HIPAA compliant encryption for transmission of claims over the hospital network.

Automated Solution
The application is installed at the hospital and runs 24/7 to ensure all claims are checked for potential third party liability.