WAG 23-08-04-c: When to Report TPL

PM 23-08-04-c.

  1. (FCRC) Use Health Insurance Report (Form 1442/1442CF) to report third party resources. The TPL Section uses Form 1442/1442CF to input data and to send a reimbursement claim to the third party. The form must be completed correctly to avoid unnecessary denial of claims by the third party and TPL reporting errors that appear on the TPL Quarterly Report from which LOPI scores are determined.
    1. Report policy limitations, such as dread disease or prescription drug only, if full medical coverage is not provided.
    2. Attach copies of insurance ID cards or premium notices, if available.

      The Financial Recovery Coordinator tracks and controls FCRC recovery activities:

  • serves as FCRC liaison to the Bureau of Collections;
  • acts as a resource for FCRC collection activities, including TPL;
  • controls FCRC TPL identification and reporting;
  • ensures all TPL documents and forms are completed and timely;
  • calls the TPL Section (217)785-9741 if help is needed completing Form 1442/1442CF;
  • signs Form 1442/1442CF, with the caseworker;
  • evaluates FCRC productivity, quality, and timeliness of TPL activities.
  1. (FCRC) Route all Form 1442/1442CF forms through the FRC for review.
  2. (FRC) Sends Form 1442/1442CF forms weekly to:
    • HFS, Bureau of Collections
    • Third Party Liability Section
    • 2200 Churchill, B-3
    • Springfield, IL 62702

      If Form 1442/1442CF cannot be processed by the TPL Section because of incomplete information and the FCRC did not indicate the efforts made to get the needed information:

  3. (TPL Section) Returns Form 1442/1442CF, along with Form 2282, to the FCRC. Form 2282 specifies the missing information needed.
  4. (FCRC) Correct Form 1442/1442CF.
    1. Return the corrected form to the TPL Section within 30 calendar days from receipt by the FCRC.
  5. (TPL Section) Forwards referrals from other sources to the FCRC. Forms used include:
    • Request for Employment Verification (Form 266B) sent to employers by the Bureau of Investigations,
    • TPL Insurance Benefits Questionnaire (Form 2453) sent to employers of insurance carriers by BOC,
    • Absent Relative Health Insurance Inquiry (Form 2593) sent to absent relatives who are ordered to provide medical support,
    • Employer Health Insurance Inquiry (Form 3110) sent by the Division of Child Support Enforcement to employers who may be ordered to enroll dependents and withhold health insurance premiums from an absent parent's wages,
    • TPL Inquiry to Pension Source - BEER Data Exchange (Form 3133) sent to pension sources to determine if health insurance is provided through the pension source.
  6. (FRC) Notifies the client by personal contact or mail of the availability of the resource if the resource is provided by a relative who is not in the benefit unit.
  7. (FCRC) Enter the 3-digit TPL resource code in Item 79 of Form 552 when reporting a TPL resource for the first time. This action also codes the MediPlan Card.

    NOTE: Do not change existing TPL codes other than "000".

    When Form 1442/1442CF is received: 

  8. (TPL Section) Updates the TPL segment of MMIS.
  9. (TPL Section) Adds the 4th digit and the alpha coverage code, which shows the type of coverage, in Item 79 of Form 552.
  10. (TPL Section) May delete the 3-digit TPL resource code if the policy is limited, such as hospitalization only or dread disease.

    To delete a TPL resource code from Item 79 of Form 552 that was entered in error by the Family Community Resource Center. 

  11. (FCRC) Copy the most recent Form 552.
    1. Note on the copy the reason for the request to delete the 3-digit TPL resource code.
    2. Send the form to the TPL Section. A cover memo is not needed.

      NOTE: The Family Community Resource Center cannot delete TPL codes. 

  12. (TPL Section) Deletes the TPL resource code.

    For AABD or GA, to resume a suspended case when a TPL resource has already been reported.

  13. (FCRC) Reenter the TPL coverage code in the first position of Item 79 if it had been entered by the TPL Section.
    1. Do not resubmit another Form 1442/1442CF for the same resource unless reporting a change.

      For TANF, when a case is being canceled with a medical extension and a new TPL resource is available: 

  14. (FCRC) Complete Form 1442.
    1. Use TA 31 to add the appropriate 3-digit TPL resource code in Item 79 of Form 552 to code the MediPlan Card.
    2. Cancel the case, approving the medical extension.
    3. Send Form 266TPL to the employer if an employed client has not reported TPL information.

      When there is updated information about TPL: 

  15. (FCRC) Report TPL resources for reopened cases, new resources after the original TPL referral is made, and changes in resources previously reported.
  16. (FCRC) Send a new Form 1442, or a copy of the case record copy, checking the "update" box.