MedicaidAdministrativeMedium impact
Insurance Report Form (TPL-4)
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Jul 23, 2020
We identified it
Jun 20, 2026
Summary
MO HealthNet is requiring all providers to submit TPL-4 (Third Party Liability) insurance report forms electronically via email to mhd.costrecovery@dss.mo.gov instead of paper forms. This change is part of their paperless initiative and affects how providers report third party insurance information.
Action Required
Immediately: Billing team must stop submitting paper TPL-4 forms and switch to electronic submission via email to mhd.costrecovery@dss.mo.gov. Update billing procedures to include email submission process for all third party liability insurance reports. Ensure staff know to use electronic method only.