TPL7
Claims Identification for TPL
CMS-required outcome
The system identifies paid claims that contain diagnosis codes indicative of trauma, injury, poisoning, and other consequences of external causes on a routine and timely basis for the purposes of determining legal liability of third parties.
Default metrics
- Frequency of claims being flagged as needing third party liability confirmation.
- Percentage of claims identified during cross-checks.
Regulatory sources
- 42 CFR 433.138(e) and (f)