TPL4
Rejection Based on TPL
CMS-required outcome
The system rejects and returns to the provider for a determination of the amount of liability for all claims for which the probable existence of third-party liability is established at the time the claim is filed.
Default metrics
- Percentage of claims rejected with a code for failure to file with a private insurer or other liable party.
- Timeliness of claims rejection and return to provider.
Regulatory sources