In an effort to gain a better understanding of providers’ ongoing needs and challenges in addressing third party liability (TPL) claims, RCPA is requesting that our members complete the following TPL Survey. This survey was designed to capture critical barriers so as to develop strategic pathways to ensuring access and equity.
In January 2024, Governor Shapiro announced that commercial insurers would be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits by categorizing autism services as a mental health benefit. With this action, all autism services will be treated as mental health services, leading to greater mental health parity for those with autism spectrum disorders. The goal of the Shapiro Administration’s legislation is to improve much-needed access to services for individuals diagnosed with autism, a challenge that the Commonwealth has faced for decades.
As providers of mental health, autism services, and substance abuse disorders, our members treat a vast array of individuals who are insured by either commercial insurance, Medicaid insurance, or both. For those who have just Medicaid, billing is simple: providers bill the Medicaid payor, and they pay the claim. The same is true for those who have just commercial insurance if the provider is in network with the commercial insurance carrier.
Complications occur when an individual has both commercial insurance and Medicaid. Coordination of Benefits (COB) requires that the commercial insurance is billed first, and then Medicaid pays what is not covered. Services like the delivery of Applied Behavior Analysis (ABA) or Intensive Behavioral Health Services (IBHS) are two good examples of services that can fall into this category.
With this survey, we hope to gather information that will assist RCPA and members in addressing the barriers in insurance coverage for children, families, and individuals in Pennsylvania. We thank you for taking the time to complete the survey so that we can continue to seek solutions to access services in our communities.
If you have any questions, please contact RCPA Policy Associate Emma Sharp.
