Claim TPL Matrix Page

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You use the Claim TPL Matrix page to add or edit TPL Matrix cost avoidance criteria.

Display Filter

Field	Description
Existing TPL Matrix cost avoidance criteria are listed in the table. To view specific TPL Matrix criteria, use the Display Filter options, and then click Filter.
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Coverage Code	The type of service that must match to display the TPL Matrix information.
Begin Date	The earliest date that the coverage code could have been associated with the TPL Matrix to display the TPL Matrix information. Format: MM/DD/YYYY
End Date	The latest date that the coverage code could have been associated with the TPL Matrix to display the TPL Matrix information. Format: MM/DD/YYYY

Field

Description

Existing TPL Matrix cost avoidance criteria are listed in the table. To view specific TPL Matrix criteria, use the Display Filter options, and then click Filter.

LOB

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

Coverage Code

The type of service that must match to display the TPL Matrix information.

Begin Date

The earliest date that the coverage code could have been associated with the TPL Matrix to display the TPL Matrix information.

Format: MM/DD/YYYY

End Date

The latest date that the coverage code could have been associated with the TPL Matrix to display the TPL Matrix information.

Format: MM/DD/YYYY

Claim TPL Matrix

Field	Description
To add TPL cost avoidance criteria, click Add TPL Matrix. To edit, in the table, click the appropriate row.
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Coverage Code	The type of service that has specific criteria defined to determine how a claim containing this service and with possible third-party policy coverage should be processed.
Begin Date	The first date that this coverage criteria is effective. May be earlier than, the same as, or later than the system date. Format: MM/DD/YYYY
End Date	The date that this coverage criteria is invalid and no longer used for processing claims dated after this date. Must be later than or equal to the Begin Date. Format: MM/DD/YYYY
Resource Type	The type of policy that normally contains this type of coverage. For example, Health or Long-term care.
Map ID	The unique identifier of the map definition that defines the specific criteria (procedure code, diagnosis code, revenue code, place of service, confidentiality code, etc.) that must be matched to post the associated exception code that determines the claim's final disposition. In the table, links to the Map Definition page for details about this map definition.
Exception to Post	The code of the exception to post to the claim that determines its final disposition (denied, paid, or suspended). The field name links to the Claim Exception page for details.
Rank	The order in which the row in the table is evaluated by ND MMIS. The lower the number, the earlier in the sequence the row is evaluated. There cannot be duplicate ranked rows within the table. Examples: 10, 20, 30

Field

Description

To add TPL cost avoidance criteria, click Add TPL Matrix. To edit, in the table, click the appropriate row.

LOB

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

Coverage Code

The type of service that has specific criteria defined to determine how a claim containing this service and with possible third-party policy coverage should be processed.

Begin Date

The first date that this coverage criteria is effective. May be earlier than, the same as, or later than the system date.

Format: MM/DD/YYYY

End Date

The date that this coverage criteria is invalid and no longer used for processing claims dated after this date. Must be later than or equal to the Begin Date.

Format: MM/DD/YYYY

Resource Type

The type of policy that normally contains this type of coverage. For example, Health or Long-term care.

Map ID

The unique identifier of the map definition that defines the specific criteria (procedure code, diagnosis code, revenue code, place of service, confidentiality code, etc.) that must be matched to post the associated exception code that determines the claim's final disposition.

In the table, links to the Map Definition page for details about this map definition.

Exception to Post

The code of the exception to post to the claim that determines its final disposition (denied, paid, or suspended). The field name links to the Claim Exception page for details.

Rank

The order in which the row in the table is evaluated by ND MMIS. The lower the number, the earlier in the sequence the row is evaluated. There cannot be duplicate ranked rows within the table.

Examples: 10, 20, 30