Contact:  (919) 647-8100
Fax: (919) 715-4725
Email: Marilyn.Vail@ncmail.net

The Third-Party Recovery Section and System Support Section (TPR) is primarily responsible for the recovery of Medicaid payments for services that should have been paid by health insurance plans and liability insurance. TPR is also responsible to ensure that accurate insurance information is on recipient files before Medicaid pays claims. Last year, the TPR Section recovered $46,710,889 and saved $1,305,285,129 through cost avoidance.

The TPR Section has 31 employees within the following units:

• Casualty Investigations: recovers Medicaid payments from other insurers due to accidental injuries, and product or medical negligence
• Post Payment: handles Credit Balance reports and audits; Estate recoveries; Medical Support Payments (IV-D); Health Insurance Premium Payments (HIPP); Medicare overpayments
• Cost Avoidance: updates recipient files for other insurance; processes claims denied for other insurance; recovers prescription drug payments; oversight of PCG contract
• Systems Support: develops queries to the Medicaid claim data warehouse (DRIVE) to support provider investigations; performs ad hoc reports of provider activities to identify areas of abuse and/or fraud; assists in maintaining the Fraud and Abuse Detection system; provides programming for TPR to use automation in place of manual processes to expedite recovery of money; collects data and provides reports of Program Integrity activities.

Updated May 28, 2008