2.1.2 Project Overview Contractor will conduct activities that will assist DSHS THMP with ensuring ADAP provides HIV medications as a safety net to fill gaps as the payer of last resort. These activities are included but not limited to: a. Contractor will identify individuals who are not eligible for ADAP because they have private or public health insurance. b. Contractor will back-bill the appropriate health insurance company for medication costs incorrectly incurred by THMP. c. Contractor will receive and safeguard confidential ADAP client data according to Exhibit H, Data Usage Agreement, Version 8.5. d. Contractor will perform monthly THMP dataset matching of listings of active insurance coverage through a Secure File Transfer Protocol (SFTP) to identify clients who have other health insurance benefits, and Third-Party Liability (TPL), including, but not limited to: 1. Private coverage; 2. Access to other public coverage; 3. Medicaid, Medicare; and 4. Veterans’ and military health programs. e. Contractor will conduct investigations when a potential TPL is identified to determine the following: 1. Effective dates of health insurance benefit coverage; 2. Prescription drug covered benefits, specifically ADAP provided medications; 3. Out-of-pocket costs (co-pays, coinsurance, or deductibles);
