Comments (0)

By Settlement Solutions, December 20, 2011 12:05 pm

CMSCenters for Medicare and Medicaid Services issued an Alert which provides an option for certain liability settlements below $25,000 to obtain a final Medicare conditional payment demand prior to settlement starting in February 2012. Under this option, the beneficiary or their representative will calculate the amount of Medicare’s conditional payment amount using information received from the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments, the MyMedicare website, or other claims information available to the beneficiary. The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments will review this amount and, if finding the amount accurate, will respond with Medicare’s final conditional payment amount within 60 days.

To secure the final conditional payment amount, the beneficiary must settle within 60 days after the date of Medicare’s response. Additionally, the alert confirms that ALL the below criteria must be met:

1. The liability (including self-insurance) settlement is for a physical trauma based injury (the settlement does not relate to ingestion, exposure, or medical implant);

2. The total liability settlement, judgment, award, or other payment will be $25,000 or less;

3. The Date of Incident occurred at least six months before the beneficiary or their representative submits the proposed conditional payment amount to Medicare;

4. The beneficiary demonstrates that treatment has been completed and no further treatment is expected either through a written physician attestation or by certifying in writing that no medical treatment related to the case has occurred for at least 90 days prior to submitting the proposed conditional payment amount to Medicare

A full explanation, including instructions on how and when to elect this option, will be available on the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments website by January 15, 2012. This option is an “initial step” to provide beneficiaries and their representatives with Medicare’s conditional payment amount prior to settlement and CMSCenters for Medicare and Medicaid Services plans to expand this option as it gains experience with this process.

At this time, the self-calculation option will only be helpful for a small portion of liability settlements. However, if CMSCenters for Medicare and Medicaid Services truly expands the option to a larger group of settlements, it would greatly assist the liability community and avert the common issue of holding the release of settlement funds pending Medicare conditional payment demand.

PMSI believes that this alert, as well as other recent MPSRC changes (as noted in our October 26, 2011 blog) is a reaction to the proposed SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011. The SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 calls for the ability of parties to obtain final conditional payment amounts prior to settlement. As the SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 continues to garner increased bi-partisan support, CMSCenters for Medicare and Medicaid Services may be looking to stay in control and avert the need for legislation to reform the conditional payment recovery process.

To view the alert in its entirety please visit the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments website.

Comments (0)

By Settlement Solutions, December 19, 2011 11:29 am

This year, 2011, was an extremely busy year for Medicare Secondary Payer Act (MSPMedicare Secondary Payer Act) related information and case law– quite possibly the busiest year in the past ten years. As 2012 is looking to be another active year, it is important to have a firm grasp and understanding of some of the information promulgated by the Centers for Medicare & Medicaid Services (CMSCenters for Medicare and Medicaid Services) in 2011, state level enforcement of the MSPMedicare Secondary Payer Act, as well as MSPMedicare Secondary Payer Act case law before moving onto 2012. Please find below a brief synopsis of some of the more seminal changes affecting MSPMedicare Secondary Payer Act compliance which occurred in 2011.

CMSCenters for Medicare and Medicaid Services Memoranda as well as full legal bulletins on most cases described below can be viewed in PMSI’s Knowledge Center under CMSCenters for Medicare and Medicaid Services Memos and Other Communications and Legal Bulletins, respectively.

CMSCenters for Medicare and Medicaid Services Memoranda

May 11, 2011- CMSCenters for Medicare and Medicaid Services reiterates their guidelines for submission of  Workers’ Compensation Medicare Set-Asides (WCMSAs) for review and approval. Submission of WCMSAs to CMSCenters for Medicare and Medicaid Services that meet CMSCenters for Medicare and Medicaid Services review threshold is a recommended (voluntary) procedure and is not mandated. Settlements with MSAsMedicare Set-Asides that fall outside CMSCenters for Medicare and Medicaid Services review threshold will not be reviewed .¹

September 29, 2011- CMSCenters for Medicare and Medicaid Services issues their first memorandum addressing liability MSAsMedicare Set-Asides (LMSAsLiability Medicare Set-asides). The memorandum states that if the treating physician certifies in writing that no future treatment is needed, that Medicare will consider its interests protected. 

MSPMedicare Secondary Payer Act Case Law

Hadden v. U.S.² – On November 21, 2011, the Sixth Circuit affirmed the district court’s opinion holding that the MSPMedicare Secondary Payer Act required Vernon Hadden to reimburse Medicare to the full extent that the government advocated. It was hoped by those in support of the appeal that the Sixth Circuit would overturn the district court’s decision, which held that the MSPMedicare Secondary Payer Act requires full reimbursement of Medicare conditional payment demands regardless of apportionment or comparative fault principles. This case may ultimately be appealed to the Supreme Court. Until such time, tortfeasors and Medicare beneficiaries can continue to expect that Medicare may obtain full recovery of their conditional payment demands, up to the amount of the settlement.

Haro v. Sebelius³- On May 5, 2011, putative class Plaintiffs, Medicare beneficiaries, and an attorney representing the beneficiaries sought a summary judgment that the Secretary’s conditional payment collection practices were not authorized by Congress, not a permissive interpretation of the MSPMedicare Secondary Payer Act, and a violation of the Due Process clause of the Constitution. The Plaintiffs further sought class certification and an injunction against CMSCenters for Medicare and Medicaid Services from making premature threats from commencing a collection action before waiver or appeal was pursued. The Court found for the Plaintiffs and granted class certification as well as an injunction against CMSCenters for Medicare and Medicaid Services as requested.

USA v. Stricker⁴- On August 12, 2011, the District Court rejected the government’s motion for reconsideration based upon a theory of continuing accrual, that the statute of limitations re-starts each time a class member receives a settlement payment. In September of 2010, the government’s complaint was dismissed due to the fact that the claim was barred by the statute of limitations (a six year statute of limitations was to be applied to those claims in which the underlying claim was contract; three years was to be applied to those claims in which the underlying claim was a tort). In November of 2011, the government filed a notice with the court that they further planned to appeal the court’s decision. Whether the government will revive their theory of continuing accrual is not yet known.

State Level MSPMedicare Secondary Payer Act Enforcement

Maryland- On November 28, 2011, Maryland enacted regulations centered on requiring the consideration of Medicare’s interests before a settlement can be formally approved. The regulations do not mandate submission of MSAsMedicare Set-Asides that meet the CMSCenters for Medicare and Medicaid Services workload review thresholds and that are purely voluntary, but require that specific items which address Medicare’s interests be contained in the settlement documents.

Kentucky- On February 3, 2011, Kentucky introduced proposed legislation which would require “settlements for future medicals to be approved by the federal Medicare Secondary Payer Act.” The proposed legislation did not pass and it is unclear whether it will be revived in 2012. 

Western District of New York- On May 6, 2011, the U.S. Attorney’s Office for the Western District of New York issued an MSPMedicare Secondary Payer Act Protocol for liability settlements. If parties to a liability settlement of over $350,000 are not able to obtain review of the LMSALiability Medicare Set-Aside by CMSCenters for Medicare and Medicaid Services and meet other certain requirements, the U.S. Attorney’s office will opine on the sufficiency of the LMSALiability Medicare Set-Aside.

MSPMedicare Secondary Payer Act Trends in Liability

Conditional Payments- In September, the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments issued an alert that it would not seek recovery of conditional payment demands where the settlement is $300 or less and other criteria are met.

Additionally, in October, the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments issued an alert that beneficiaries who receive a liability settlement of $5000 or less and meet other criteria can pay a fixed percentage of their settlement instead of opting for the traditional recovery process. For more information, please visit www.msprcMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments.info.

Liability MSAsMedicare Set-Asides (LMSAsLiability Medicare Set-asides)- In both of the following cases which occurred in 2011, the court included or required an LMSALiability Medicare Set-Aside to consider Medicare’s interests as part of the liability settlement: Hinsinger v. Showboat Atlantic City⁵ and Big R Towing v. Benoit⁶.

Legislative Proposals

Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011) – This bill was introduced to the House of Representatives on March 14, 2011. The SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 seeks reform of the enforcement of the MSPMedicare Secondary Payer Act, namely as it affects conditional payment collection and MMSEAMedicare Medicaid and SCHIP Extension Act Mandatory Insurer Reporting. Some examples of initiatives proposed would be to set the statute of limitations for conditional payment reimbursement at three (3) years, and make the MMSEAMedicare Medicaid and SCHIP Extension Act penalty of $1000 per claim/per day discretionary rather than mandatory. The SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 gained large bi-partisan support in the House and moved to the Senate in October of 2011. Whether the bill will pass in the Senate remains to be seen as we move into 2012.

In conclusion, 2011 was a very busy year for those affected by the MSPMedicare Secondary Payer Act. We saw a dramatic rise in MSPMedicare Secondary Payer Act case law, more states creating requirements for Medicare’s interests to be considered as part of settlements, increased awareness surrounding liability MSAsMedicare Set-Asides, and reform efforts surrounding MSPMedicare Secondary Payer Act enforcement.

^{1. [The CMS review thresholds remain unchanged and are the following: Class 1: Medicare Beneficiary and Total Settlement Amount exceeding $25,000; Class 2: Reasonable Expectation of Medicare Entitlement within 30 months of the Settlement date and the anticipated Total Settlement Amount exceeds $250,000.]↩}

^{2. [2011 U.S. App. LEXIS 23289, United States Court of Appeals for the Sixth Circuit.]↩}

^{3. [CV 09-134 TUC DCB, (D.AZ.) (May 5, 2011). ]↩}

^{4. [No. CV-09-BE-2423-E (N.D. Ala. Aug. 12, 2011).]↩}

^{5. [No. CV-09-BE-2423-E (2011 N.J. Super LEXIS 96 (January 21, 2011).]↩}

^{6. [2011 U.S. Dist. LEXIS 1392 (W.D. La. Jan. 5, 2011). This case involved a Jones Act claim which is considered a liability claim for CMS submission purposes.]↩}

Comments (0)

By Settlement Solutions, December 15, 2011 2:35 pm

In a previous blog dated September 23, 2011, we announced the confirmation that the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments contract which was previously held by Chickasaw Nation Industries (CNIChickasaw Nation Industries) would not be renewed when it expired on September 30, 2011 (the contract had been in effect since 2006).  CMSCenters for Medicare and Medicaid Services confirmed that they would be seeking to establish a centralized Coordination of Benefits (COBCoordination of Benefits Program) and Medicare Secondary Payer Recovery (MSPRMedicare Secondary Payer Recovery) operation by consolidating the two units.   In the interim, Group Health Incorporated (GHIGroup Health Incorporated) will be overseeing the recovery process. 

On December 8, 2011, CMSCenters for Medicare and Medicaid Services posted an RFPRequest for Proposal (Solicitation Number: RFPRequest for Proposal-CMSCenters for Medicare and Medicaid Services-2011-0048) for an MSPMedicare Secondary Payer Act Business Program Operations Contract to establish a centralized operation by consolidating under a single program, the performance of all activities that support the collection, management, and reporting of other insurance coverage of Medicare beneficiaries, and the collection of mistaken primary payments. The intent of the consolidation is to provide quality customer service and a single source to Medicare providers, suppliers, beneficiaries, insurers, and other stakeholders by streamlining the MSPMedicare Secondary Payer Act data and debt collection processes while ensuring the integrity of the Medicare Trust Funds.

PMSI believes that the industry would welcome this integration with the hope that it will lead to an improvement in the overall recovery process, particularly the length of time currently involved in verifying and resolving conditional payments.  We will continue to monitor the transition as well as the RFPRequest for Proposal process and will post additional information as it is received. 

Comments (0)

By Settlement Solutions, December 13, 2011 4:28 pm

Regulatory guidelines for MSPMedicare Secondary Payer Act and MMSEAMedicare Medicaid and SCHIP Extension Act compliance are frequently changing, and it is no surprise that the reach of the types of entities impacted by these laws are constantly changing as well.  Multiple entities can be involved in the process of managing and handling claims, such as insurance carriers, employers, and third party administrators. In reference to MMSEAMedicare Medicaid and SCHIP Extension Act Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting , reporting agents also come into play.  With such hefty fines threatened with non-compliance ($1000 per claim/per day), it is important for everyone involved in this process to understand their roles and obligations. 

Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting reporting has become an important factor to consider when a transition in these relationships occurs. Examples of these types of transitions include switching TPAsThird Party Administrators or an acquisition of one RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA by another RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA. Insurance carriers and employers who are RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA now need to consider a new reporting structure and/or process in order to remain compliant with Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting guidelines during the transition. Points to consider include:

• Which claims are involved in the take over process?
• Are any additional RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs required and/or do any need to be placed in an inactive status?  
• Is there a change in reporting agent?
• Has there been a change in RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA responsibility?
• When will the change take place?
• What is the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA’s quarterly reporting schedule?

Transitional Relationship Scenario #1- New TPAThird Party Administrator
When transitioning claims from one TPAThird Party Administrator to another, an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA will need to identify which claims will be involved in the takeover process.   For example, will a new TPAThird Party Administrator be handling only new claims for an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA on a go-forward basis or will they also be taking over existing claims? If only new claims will be moving to the new TPAThird Party Administrator, it is possible that a new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID will be needed, depending on how each TPAThird Party Administrator is handling Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting reporting.  Section 8.2 of the NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation User Guide states the following in regard to multiple RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs: “Only one Claim Input File may be submitted on a quarterly basis for each RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID. Due to corporate organization, claim system structures, data processing systems, data centers and agents that may be used for data submission, you may want to submit more than one Claim Input File to the COBCCoordination of Benefits Contractor on a quarterly basis and therefore will need more than one RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID in order to do so.”

On the other hand, an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may have the option to discontinue using a previously established RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID if claims will now be administered by TPAsThird Party Administrators utilizing the same reporting agent.  If multiple RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs were obtained, the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may be able to condense reporting under fewer RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs based on the new reporting structure.

Transitional Relationship Scenario #2- New Reporting Agent
If an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA is changing reporting agents, the new agent should continue to submit files under the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA’s existing RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID(s). The COBCCoordination of Benefits Contractor cannot supply a file of previously submitted and accepted records for the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs.  The RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA will need to ensure the new reporting agent is granted access to the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID via the COBSWCoordination of Benefits Secure Website by inviting the appropriate members of the new agent as account designees. If applicable, the new reporting agent may take on the account manager role, for which a written request will need to be made to the EDI Representative. 

Section 8.3.3 of the NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation User Guide states, “Updates to other information such as changing reporting agent, changing from one file transmission method to another, changing from DDE to a file transmission method, overriding the 500 claim limit for DDE, or changing the TINTax Identification Number associated with the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID must be requested through your EDI Representative. You must also contact your EDI Representative to change your Authorized Representative or Account Manager to a different individual.”

The new agent will only be able to submit and access files for the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA once these changes are made.  In addition, the account manager should ensure account designees associated with the previous reporting agent or associated organizations are removed.

Transitional Relationship Scenario #3- Change in RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA
It is also possible for a change in RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA to occur.   According to CMSCenters for Medicare and Medicaid Services, the transition of reporting responsibility in whole or in part, from one RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA to another is the responsibility of the entities involved.  If this occurs, it is important to ensure that the COBCCoordination of Benefits Contractor no longer expects claims to be submitted under existing RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID(s) by submitting a written request via email to the assigned EDI Representative requesting that the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID be placed in an inactive status.  If production files were never submitted under the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID, then the ID can be deleted.

Section 8.3.2 of the NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation User Guide states, “the new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may register for a new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID or report the transitioned claim records under one of its existing RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs. The new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may update and delete records previously submitted by the former RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA under a different RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA ID as long as the key fields for the records match. Key fields are injured party HICNHealth Insurance Claim Number or SSNSocial Security Number, CMSCenters for Medicare and Medicaid Services date of incident, plan insurance type (liability, no-fault, or workers’ compensation) and ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) indicator. The RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA IDs do not need to match. The former RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA must NOT delete previously submitted and accepted records. If the ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) previously reported has ended, then update transactions should be sent with applicable ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) Termination Dates. The new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may send add transactions for new ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) and new claims with TPOCs or update transactions to change existing records with new information such as the new RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA TINTax Identification Number.”

It is important that the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA will need to identify whether the date of any transition will interfere with their quarterly reporting schedule.  If there is any risk that claims may not be submitted through the query process or for the quarterly submission timely, they should notify the EDI Representative regarding the details of the transition or takeover process and coordinate the proper steps that should be taken to avoid any potential risk.

Whether the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA role is transitioning to you or away from you, you will have a role to play within this process. CMSCenters for Medicare and Medicaid Services makes this clear by stating that the “transition of reporting responsibility from one RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA to another is the responsibility of the RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA involved.” It is important to understand the tasks involved, your responsibility in the process, and any issues with regard to the timing of the change. Communication between the RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA, reporting agents, and the COBCCoordination of Benefits Contractor is essential and should be coordinated to ensure a smooth transition. The transition of claim responsibility from one RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA to another can be a complex task with several moving parts but with careful synchronization and communication, the daunting task can be accomplished. 

Regardless of the type of transition taking place, changes with respect to Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting can be complicated but must be effectuated correctly or noncompliance can occur. PMSI recommends that you consult with your reporting agent, CMSCenters for Medicare and Medicaid Services, COBCCoordination of Benefits Contractor, as well as the User Guide and/or any other available written guidance from CMSCenters for Medicare and Medicaid Services prior to undertaking any of these transitions.