![]() Refer to Third Party Liability for the appropriate code. The 3 digit carrier is required for claim with a primary insurance. Third Party Liability (TPL) Carrier Codes Use the Healthcare Portal (Please see the Healthcare Portal page for information on how to register or use the site) or call the Customer Service Help Desk to find out if a recipient is eligible for Medicaid.įor information on how to obtain Prior Authorization. Third Party Liability Procedural Information Recoupment Form Recoupment Form Instructions A copy of the the Remittance Advice page is required with the Adjustment Form in order for processing.Īdjustment Form Adjustment Form Instructions
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