MedicaidAdministrativeHigh impact
[Indiana] Third Party Liability (TPL)
CareSource·IN·Provider Bulletin
Effective date
Jul 29, 2026
We identified it
Jul 29, 2026
Summary
CareSource has updated its Third Party Liability (TPL) policy for Indiana Medicaid members (Hoosier Healthwise and Healthy Indiana Plan). Providers must now bill third-party insurance resources BEFORE billing CareSource and submit documentation of the primary insurance explanation of payment with corrected claims. Claims submitted to CareSource without TPL billing documentation will be denied per federal regulation 42 CFR 433.139.
Action Required
Immediately: 1) Billing team must implement workflow to verify TPL coverage for all CareSource members before claim submission by accessing the CareSource Provider Portal. 2) Update billing system to flag claims requiring TPL verification and block submission to CareSource until primary TPL resource is billed. 3) Establish procedure to collect and attach primary insurance explanation of payment with all TPL-related corrected claims submitted to CareSource within timely filing guidelines. 4) Train all billing and clinical staff that TPL documentation must be submitted via standard claim processing procedures only—NOT through claim disputes. 5) Update claim denial resolution procedures to handle TPL denials by requiring submission of corrected claims with primary insurance EOB. Consequences: Claims submitted without TPL documentation will be denied by CareSource, and dispute submissions will not be accepted as valid correction method, delaying reimbursement.