Third Party Liability (TPL) Sanction

Created on: 
Oct 26 2015

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is a Third Party Liability (TPL) Sanction?

Clients must cooperate in identifying, using or collecting third-party benefits. If a client does not cooperate with the TPL process, their health care coverage may end unless they can show good reason not to cooperate. For more information, see Apple Health eligibility manual - WAC 182-503-0540 Assignment of rights and cooperation.

Online Processing

How do I process a Third Party Liability (TPL) sanction?

To process a TPL sanction, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. Click Start Changes in the Change of Circumstances section on the Case Actions page.
  3. On the Client Details page in the TPL/Eligibility Established section, select No (N) from the drop-down list for the TPL Cooperation field.
  4. On the Eligibility Details page, confirm the following and click Confirm Benefits:
  • Financial Responsibility field - CA/MA Sanctioned (DI).
  • Reason field - Non-Cooperation with TPL (266).
  1. On the Eligibility page, click Commit Changes.
NOTE: Pregnant women and children under 19 years of age are not subject to sanction for non-cooperation. Entering No (N) in the TPL Cooperation field has no effect on eligibility in these cases.

How do I lift a Third Party Liability (TPL) sanction?

To lift a TPL sanction, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. Click Start Changes in the Change of Circumstances section on the Case Actions page.
  3. On the Client Details page in the TPL/Eligibility Established section, select Yes (Y) from the drop-down list for the TPL Cooperation field.
  4. On the Eligibility Details page, confirm the Financial Responsibility field displays Recipient (RE) and click Confirm Benefits.
  5. On the Eligibility page, click Commit Changes.

Mainframe Processing

How do I process a Third Party Liability (TPL) sanction?

To process a TPL sanction, take the following steps:

  1. On AMEN screen, enter Option [R] - Interim/Hist Change in the Selection field.
  2. On DEM2 screen, in the TPL Coop field enter [N] - No.
  3. Call DONE and the ELIG screen displays.
  4. On the ELIG screen, confirm the following for the client and commit the data:
  • Finl Resp field - [DI] -CA/MA Sanctioned.
  • Rsn field - Reason Code 266 - Non-Cooperation with TPL.
NOTE: Pregnant women and children under 19 years of age are not subject to sanction for non-cooperation. Entering [N] - No in the TPL Coop field has no effect on eligibility in these cases.

How do I lift a Third Party Liability (TPL) sanction?

To lift a TPL sanction, take the following steps:

  1. On AMEN screen, enter Option [R] - Interim/Hist Change in the Selection field.
  2. On DEM2 screen, in the TPL Coop field enter [Y] - Yes.
  3. Call DONE and the ELIG screen displays.
  4. On the ELIG screen confirm the client has Finl Resp code [RE] - Recipient.
  5. Verify and commit the data.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.