PMSI Settlement Solutions
PMSI was the first workers’ compensation company to integrate Medicare Set-Aside (MSAMedicare Set-Aside) services into a comprehensive portfolio of pharmacy and medical services programs. We continue to innovate to meet the evolving needs for Medicare Secondary Payer (MSPMedicare Secondary Payer Act) compliance regulations in workers’ compensation and liability settlements. Applying the industry’s deepest knowledge bank of pharmacy, medical, claims, and legal expertise, we consistently deliver proven solutions for cost containment.
Through our dedicated Government Affairs team, we maintain a strong and active regulatory presence, keeping a constant pulse on legislative developments in all 50 states and address compliance requirements real time to deliver insightful solutions for critical business issues. We actively work as an advocate for our clients to ensure that requirements are met and appropriately applied. PMSI’s Government Affairs team is at the forefront of guiding policies that protect the interests of our clients and their injured workers. Over the years, PMSI has cultivated long-term relationships with CMSCenters for Medicare and Medicaid Services, state government agencies, regulatory officials and key legislators—allowing for regular communication about pending regulation/legislation—and the opportunity to effect meaningful change for the industry.
PMSI’s Settlement Solutions division is a premier provider of MSAMedicare Set-Aside allocations and a leader in MSPMedicare Secondary Payer Act compliance education, preparation and programs. PMSI’s focus involves providing innovative services that help drive down settlement costs while maintaining regulatory compliance. We are recognized as the industry-leading advocate on issues such as prescription allocations in MSAsMedicare Set-Asides that limit the ability of payers to achieve fair and equitable settlements and impede business productivity. From formulating medically based alternative methodologies for regulatory consideration to developing new solutions as industry needs unfold, we use our unique set of multi-disciplinary competencies to support understanding and communication across the industry.
Based on our extensive and long-standing experience in working with CMSCenters for Medicare and Medicaid Services, we are at the forefront of Mandatory Insurer Reporting (MIRMandatory Insurer Reporting) compliance, as required by Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting of the Medicare, Medicaid and SCHIP Extension Act (MMSEAMedicare Medicaid and SCHIP Extension Act) of 2007. By integrating our core competencies in MSAsMedicare Set-Asides, client connectivity, state reporting and information technology, PMSI has created MedicareConnectSM, a comprehensive solution for MMSEA111 reporting that delivers a 95% acceptance rate on submissions to CMSCenters for Medicare and Medicaid Services. As the reporting process continues to mature, we deliver insights on the latest developments and direction from CMSCenters for Medicare and Medicaid Services to support industry-wide compliance.
Learn more about PMSI’s Settlement Solutions.