Florida Medicaid TPL Recovery Program fax number

Fax destination details

Department

Third-Party Liability (TPL) Recovery Program

Purpose

Submitting health insurance information to verify or reverify a Medicaid recipient's private health insurance coverage.

Form

Health Insurance Information Referral Form

Address

Florida Medicaid TPL Recovery Program, P.O. Box 12188, Tallahassee, FL 32317-2188

Voice phone

1-877-357-3268

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Fill required fields: Recipient's last name and first name; Medicaid ID or Gold Card Number; SSN (optional); Insurance Company Name; Policy Number; Policy Begin Date; Policy End Date; Insured's last name and first name; Employer; Address/Zip; Reason for referral; Tracking ID. Then submit to the Florida TPL Recovery Program.