Beneficiary Third Party Liability Data Migration (IB 24-39)

Date: 10/23/24

Louisiana Healthcare Connections is sharing communication that Gainwell Technologies is currently planning and preparing for the migration of Louisiana Department of Health Medicaid members’ Third Party Liability (TPL) policy data from the current Master Resource File (MRF) to the Beneficiary Third Party Liability Database (BTPL).External Link

The transfer and reconciliation of this TPL policy data is scheduled to start on November 4, 2024 and end on November 19, 2024. In order to avoid any inadvertent impact on the processing of claims due to TPL cost avoidance and pay and chase, Louisiana Medicaid is requesting non-pharmacy providers hold submission of all claims with new TPL (except pharmacy and crossover claims) from November 4, 2024 through November 19, 2024. Existing claims may be filed as usual during this time. The intent of the requested pause in claims submissions is to expedite the payment of claims to providers. All new claims held by providers during this time can be submitted once the data migration/reconciliation is complete. Any claims submitted during this time period may need to be readjusted. Holding claims during this period will help minimize a potential backlog and make the processing and payment of claims faster and more efficient as we navigate this data migration.

Regarding fee-for-service (FFS) pharmacy claims: This process will only impact FFS pharmacy claims for beneficiaries who have a change in their non-Medicaid other third party insurance for a limited period of time. This will not impact Medicare Part D eligible beneficiaries.

The transfer and reconciliation of data from November 4, 2024 through November 19, 2024 will require some system changes. During this interim, providers should bill using Other Coverage Code value “01” using NCPDP field 308-C8 for beneficiaries whose eligibility file indicates there is other third party coverage, but the coverage has terminated