Integrating Social Security and Medicare for Cost-Effective Solutions

MMSEA and Mandatory Insurer Reporting

Satisfy Compliance Responsibilities set by Medicare
 
MMSEA Section 111
 
Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) requires the providers of group health plans, liability insurance (including self-insurance), no-fault insurance and workers’ compensation insurance to determine the Medicare entitlement of all eligible claimants and report certain information about those claims to the Centers for Medicare & Medicaid Services (CMS).
 
The purpose of this legislation enables CMS to pay correctly for Medicare covered items and services on behalf of Medicare beneficiaries by determining primary vs. secondary payer responsibility. The penalty for non-compliance is $1,000 per claim for each day. This penalty is in addition to other fines that Medicare may impose if Medicare’s reimbursement claim is ignored in any settlement. The new rules will apply to settlements on or after July 1, 2009 for liability insurance (including self-insurance), no-fault insurance and workers’ compensation insurance.
 
Responsible Reporting Entities (RRE) -- liability insurance and self-insurance, no-fault insurance, and workers’ compensation laws and plans -- will be required to begin active reporting to CMS. Under Section 111, any time a claim is filed the plan will need to determine whether the claimant is eligible for Medicare. When the RRE encounters a claimant who is so entitled, the RRE must “report the identity of such claimant and provide such other information as the Secretary may require.” As CMS has revealed, the other information equates to more than 100 distinct fields of data.
 
Reporting
Reporting will be ongoing, on a quarterly basis, for no-fault insurance and non-contested workers’ compensation claims, and on a one-time basis for all contested cases in which there is “a single settlement, judgment, award or other payment.” Failure to report carries a penalty of $1,000 per claim per day of non-compliance.
 
Why Allsup?
Allsup offers a complete program of Medicare Secondary Payer (MSP) Compliance services to ensure consistent, cost-effective and measurable compliance with federal provisions.
  • Verify Medicare entitlement dates and status
  • Analyze the need for Medicare Set-Aside (MSA) allocations and submissions
  • Determine Medicare Set-Aside amount
  • Inquire about Medicare Conditional Payment lien status
  • Provide Medicare beneficiary notifications
  • Provide Medicare conditional lien verifications and resolutions
  • Establish allocation amounts
  • Electronically submit to CMS for approval
  • Expedite MSA completion
A Comprehensive Reporting Solution
Allsup has developed its MMSEA Mandatory Insurance Reporting (MIR) Service to assist insurers in easily complying with the mandatory provisions of MMSEA Section 111. Our comprehensive reporting solution provides guidance from the registration process through data testing and reporting.
 
Allsup has superior IT and programming resources, proficiency in data review and error identification and extensive experience in reporting claims data to Medicare.
 
Allsup’s MMSEA MIR Service is designed to:
  • Determine Medicare-eligibility status of claimants in an efficient manner
  • Determine MIR cases, Medicare Set-Aside and Conditional Payment claims
  • Identify all reporting errors prior to reporting
  • Report and interact with CMS, COBC and Medicare Secondary Payer Recovery Contractor (MSPRC) in order to minimize the impact to claims personnel
  • Discover, verify and negotiate conditional liens associated with MSP compliant claims
  • Provide a variety of MIR status reports on our secure website
Responsible Reporting Entities (RREs) must register with the Coordination of Benefits Contractor (COBC) and provide notification of their intent to report data in compliance with the requirements of Section 111 of the MMSEA. Registration by the RRE must be completed before testing can begin.
 
The Allsup MMSEA MIR Service is set up to receive and transmit data per CMS specifications. Our reporting functions are designed to transmit data protocols (MSP input file), test data completeness, receive data back (MSP response file), receive and process error files, report errors and maintain a history (MSP occurrences) and audit trail. System interface support includes:
  • Mass data transfer of all applicable data
  • Web portal data entry and correction
  • Format compliance review of all data prior to submission to CMS
Claims Reporting
CMS continues to update the distinct procedures and data reporting formats related to mandatory insurer reporting. Our service can help support insurers’ quarterly reporting based on COBC established reporting timeframes. As an RRE, the workload and maintenance of your compliance program may also require the dedication of staff to oversee your compliance.
 
Working with Allsup as your MMSEA Section 111 MIR partner can help streamline your processes, procedures and staff time commitment to ensure compliance.
 
The Allsup Advantage
The Allsup MMSEA MIR Service offers valuable benefits, including:
  • Monthly query function via CMS’s HEW Query software: data receipt from RRE, compliance review, CMS transmission, process COBC response and report back to RRE
  • CMS submission testing
  • Quarterly CMS submission of new, updated and deleted records; review and report on response files
  • Secure Web portal access for updating records, checking status and reporting
  • Exchange of data between RRE and Allsup via mass upload and/or manual entry via secure Web portal
  • Scheduling notification to claims examiners
  • Dedicated Allsup Reporting Manager (RM) specifically assigned to RRE; responsible for ensuring timely data transfer between all parties, informing RRE of reporting updates and changes from CMS, providing superior customer service to RRE, which includes answering questions, resolving issues, setting up notifications, and specialized reporting
  • Response file analysis and reporting performed by the RM after evaluating CMS’s disposition, error, and compliance flag codes and developing processes to compile data consistently beneath CMS’s file error threshold
  • Data storage for 10 years per the MMSEA NGHP user guide
Contact Allsup
Contact Allsup at (866) 477-7005 or click here to e-mail us for more detailed information about how Allsup’s MMSEA MIR Service can help your organization.