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TPHI


Third Party Health Insurance Unit function is to practice numerous cost avoidance measures while maintaining a quality level of care for the Medicaid population. We provide support to medical providers and other divisions within Erie County and New York State government who service Medicaid recipients. This unit is responsible to investigate and verify any Third Party insurance and to enter it on the EMedNY system thereby reducing or avoiding unnecessary Medicaid expenditures. This unit pursues Medical coverage and reimbursement for Medicaid payments from legally responsible relatives as ordered by the courts.

Our top priorities are to enter new insurance daily and delete old insurance to keep the system updated to avoid problems for Medicaid recipients.

To enter new recipients on the Medicare Savings Program (MSP) Program and to delete those who are no longer eligible.

To make Cobra and premium payments for those who are eligible.

To deal with providers and clients to resolve problems.

Cost Avoidance Report is a Monthly report designed as a management tool to provide local districts and the Department with data regarding the dollar amount (and corresponding percentages) of the contributions (offsets), from Third party resources which reduce the amount paid by Medicaid. This report is a monthly report that monitors the increases or decreases in the amount of contributions.