It is common for people eligible for Medicaid to have one or more additional sources of coverage for health care services. Third Party Liability (TPL) refers to the legal obligation of third parties to pay part or all of the expenditures for medical assistance. By law, all other available third party resources must meet their legal obligation to pay claims before Medicaid pays for the care of the individual.
- Pharmacy third-party recovery services for people enrolled in Medicaid managed care are administered by the person's managed care organization (MCO). Please refer to the Pharmacy Assistance Chart (PDF) for pharmacy call center phone numbers and cost-avoidance and coordination of benefits processes and instruction.
- Traditional Medicaid (fee for service) third-party (non-Medicare) recovery is administered by the Texas Third-Party Call Center. Call center staff will verify requests within three business days and provide updates to allow for claim processing.
Texas Third Party Call Center
1-866-389-5594: Monday-Friday, 8:30 a.m. to 5:30 p.m. (central time)
Pharmacy staff or people enrolled in traditional Medicaid may call regarding third-party status.