MedicaidAdministrativeHigh impact
[Indiana] Third Party Liability (TPL)
CareSource·IN·Provider Bulletin
Effective date
Dec 11, 2025
We identified it
May 9, 2026
Summary
CareSource is reinforcing that Indiana Medicaid providers must bill third-party liability (TPL) resources before submitting claims to CareSource, as required by federal regulation 42 CFR 433.139. Claims submitted without documentation of TPL billing will be denied; providers must resubmit with primary insurance explanation of payment to resolve denials.
Action Required
By December 11, 2025 (effective immediately): (1) Billing team must implement workflow process to check CareSource Provider Portal for TPL resources before submitting any claim for HHW or HIP members. (2) Update billing system to require documentation of TPL billing attempt or exception justification before claim submission. (3) Training: Ensure all billing staff understand that claims without TPL billing documentation will be automatically denied per federal regulations. (4) For denied claims due to TPL: Obtain primary insurance explanation of payment and resubmit corrected claim within timely filing guidelines. (5) Providers should contact CareSource Provider Services at 1-844-607-2831 (Mon-Fri, 8am-8pm ET/7am-7pm CT) for assistance accessing the Provider Portal or navigating TPL requirements. Failure to bill TPL first will result in claim denials that require rework and resubmission.