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TPL and 3rd party billings

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  • TPL and 3rd party billings

    I was hoping that someone might have some ideas on how to handle TPL (Third Party Liability) or multiple billings.

    We have a program we have written for companies who provide services to people with disabilities. The system works like this:

    Company receives a referral (usually from a State government agency) to provide service to a person. This could be something like providing an Attendant Care service for 40 hours per month for 5 months. This is the easy part.

    The tough part is how to handle billings when the State is the payer of last resort. What that means is that the State will pay for the service only after an insurance company or companies denies payment. It may also be a thing where there is more than one insurance company involved and one of them may pay, only if another insurance company does there is a priority system involved.

    In our Service Order table and time entry table we have made provision for only one payer. Now we need to figure out a way to track more than one payer, in order of priority. That of course means how to track the payers, when it was billed, when the claim to the payer was denied and how to have the system pick up the next payer in the priority scheme and bill it.

    I haven't been asked yet, but I can see it coming, but I suppose there will be times when more than one insurance company will take responsibilty for a billing. That means that a bill for 10 hour of service would be paid by billing 40% to one company and 60% to another, each of which will want the full period of service with only their share being billed to them.

    So my question...has anyone had any experience with this? or do you have some thoughts on how I might set this up?

    Mike Reed

    BTW, I have posted this message on both the version 6 and version 7 forums, to try to pick up different audiences.
    Mike Reed
    Phoenix, AZ

  • #2
    Re: TPL and 3rd party billings

    This should be very simple to do with one-to-many set.
    In the parent table you enter the name of the disabled, in the child table you enter records showing responsible party(s). The child table will have a field for priority to show who is first responsible.

    Most likely you will need one script or another to:
    a-Bill the second company in line if the first declines
    b-Calculate who paid what and what is the remaining balance.