OPAR

The Health Insurance Group verifies third party insurance (TPL) for Medicaid eligible clients. If the insurance meets TPL criteria HIG updates MMIS (Medicaid Management Information System) which is the Medicaid claims payment system. When TPL is accurate in MMIS, Medicaid claims pay or deny correctly.

How is TPL reported to HIG?

Oregon medical assistance clients, providers and DHS/OHA staff report private health insurance changes online at www.reporttpl.org. A current internet browser such as Chrome, Firefox or Internet Explorer versions 9 and up is required.

Who needs to report TPL?

Anyone who gets Oregon medical assistance (see 42 CFR 433.138) is required to report when they are covered by other health insurance. They also need to report if the insurance ends or if there are changes to the policies. Providers and coordinated care organizations who provide services to individuals covered by Oregon Medical Assistance programs also need to report if they discover TPL information that is different from the information the state currently has. TPL can be reported by clients, DHS/OHA staff, providers, application assisters or coordinated care plans.

What kind of health insurance needs to be reported?

Anyone covered by Oregon medical assistance is required to report insurance that:

  • Is through a job (employer-sponsored health insurance).
  • Was purchased from an insurance company (commercial health insurance), including Medicare Supplements.
  • Is student insurance.
  • Is provided by someone who does not live in the same household as the medical assistance client.

The following types of insurance do not need to be reported:

  • Medicare A, B, C, D or Medicare Advantage (Replacement) policy information
  • Car insurance
  • Homeowner’s insurance

Does Oregon have a premium assistance program?

Yes. Oregon’s Health Insurance Premium Payment (HIPP) program reimburses eligible policyholders for the cost they pay for their insurance. See our HIPP page for more information.

What will DHS/OHA do with this information?

If you have current coverage, DHS/OHA will only use this information to make sure that your insurance company pays for services you get from your health care providers.

Contact HIG

For questions about third-party insurance:

Resources

hig3.jpg