CMS Clarifies Reporting Threshold for Liability Settlements

On February 19, 2014, we issued a blog notifying subscribers that CMS had issued a Liability Insurance Reporting and Recovery Threshold pursuant to the SMART Act of $1000. On February 28, 2014, CMS issued another alert clarifying that its reporting threshold will be moved from $300 to $1000 for liability claims resolved on/after October 1, 2014.

The alert states the following:

An updated MMSEA Section 111 Non-Group Health Plan (NGHP) User Guide, Version 4.2, Chapters I – V is now available in the Downloads section of the NGHP User Guide page. This version documents the change in reporting threshold for certain liability insurance (including self-insurance) settlements, judgments, awards, or other payments. Please refer to page 1-1 of each Chapter for a summary of updates made.

The Centers for Medicare & Medicaid Services (CMS) would like to clarify for certain liability insurance (including self-insurance) settlements, judgments, awards,
or other payments:

  • The current mandatory reporting threshold for liability insurance (including
    self-insurance) Total Payment Obligation to the Claimant (TPOC) is $2000 and
    over for TPOCs dated on or after October 1, 2013.
  • The mandatory reporting threshold for liability (including self-insurance) TPOCs dated October 1, 2014 and after is changing from $300 to $1000. If the most recent TPOC Date is on or after October 1, 2014, and the cumulative TPOC Amount is greater than $1000, the TPOC(s) must be reported no later than the end of the RRE’s submission timeframe in the quarter beginning January 1, 2015.
  • Error code CJ07 has not been updated to reflect this change. Further guidance will be provided at a later date concerning changes to this error code to coincide with the new reporting threshold of $1000.

These changes will also be applied to the downloadable version of the MMSEA Section 111 Coordination of Benefits Secure Website (COBSW) User Guide, available on the COBSW.

 

Leave a Reply