27-79-01: TPL Coverage Code (lst Place of Item 79) (Centrally Entered)

After the FCRC reports the TPL resource in the 2nd, 3rd, and 4th positions, the TPL Section enters a letter in the first position when a third party resource is verified and the extent of the coverage is determined. Do not change these codes.

NOTE: If the TPL resource has not changed, reenter this code when resuming a suspended case. If the TPL resource has changed, wait until the TPL Section reassigns a new code.

TPL COVERAGE CODE	DESCRIPTION	PAYS FOR ALL OR PART OF THESE SERVICES
A	Comprehensive Health Insurance (Level 1)	Inpatient/Outpatient Hospital, Clinic, Physician, Podiatrist, Laboratory, Transportation, Long Term Care, Dental, Optometrist
B	Comprehensive Health Insurance (Level 2)	Inpatient/Outpatient Hospital, Clinic, Physician, Podiatrist, Laboratory, Transportation, Long Term Care, Dental
C	Comprehensive Health Insurance (Level 3)	Inpatient/Outpatient Hospital, Clinic, Physician, Podiatrist, Laboratory, Transportation
D	Basic Benefits and Major Medical	Inpatient/Outpatient Hospital, Physician, Podiatrist, Laboratory, Transportation
E	Basic Benefits	Inpatient/Outpatient Hospital, Physician
F and G	Hospitalization - Inpatient/Outpatient Levels 1 (F) and 2 (G)	Inpatient/Outpatient (Coverage code F provides more coverage than code G.)
H and I	Limited and Indemnity Policies	Accident Only, Cancer Only, etc.