ISO ClaimSearch Adds Medicare Secondary Payer Reporting Service

February 23, 2009

ISO ClaimSearch, a property/casualty insurance industry claims information system, added a new regulatory compliance service: the ISO ClaimSearch Medicare Secondary Payer Reporting Service.

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (P.L. 110-173) adds new mandatory reporting requirements for group health plan arrangements and for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation. The legislation requires reporting of bodily injury claims filed by Medicare-eligible claimants to the Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS). The requirements apply to insurers and self-insured organizations.

The ISO ClaimSearch Medicare Secondary Payer Reporting Service will report Medicare-eligible claimants to CMS on behalf of ISO ClaimSearch participating companies in conformance with the legislation. Reporting through ISO will provide insurers and self-insureds with significant savings and process efficiencies by leveraging the existing claims reporting process for companies using the ISO ClaimSearch Universal Format reporting specifications.

ISO, in conjunction with insurers and the insurance trade associations, has held discussions with CMS about the required data elements and reporting processes. ISO’s service — including a Medicare-eligibility query function, data collection and editing, automated claim file submissions, and processes for handling CMS acknowledgment and rejection notices — will allow ISO ClaimSearch customers to comply fully with the mandate.

Companies are required to register their data-reporting method with the CMS by June 30, 2009. CMS will assign a quarterly reporting period to each required reporting entity at registration. Companies must be ready to test reporting to CMS on July 1, 2009. The deadline for submission of production files based on the predetermined quarterly reporting schedule is January 1, 2010. All applicable claims open as of July 1, 2009, must be reported. ISO will support the testing process and manage the quarterly submissions on behalf of companies that subscribe to the ISO ClaimSearch Medicare Secondary Payer Reporting Service.

Source: ISO

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