The reporting required by CMS to fulfill Mandatory Insurer Reporting (MIR) requirements went live on January 1, 2011. The processes to achieve full compliance are complex and require extensive technology, data scrubbing and timely submission for entities that must report claims. Many reporting entities have encountered difficulties, including significant issues with data validation—resulting in either not reporting eligible claims or unnecessarily reporting ineligible claims to CMS. These data issues can increase risk for payers, as data reported with errors can result in temporary suspension of reporting with CMS, increasing the risk of non-compliance penalties. Following is a sample of some of the challenges RREs face in meeting compliance and the potential results of these issues.
Over the past year CMS has been seeking a new and qualified vendor to take on the role of the WCRC through a Request for Proposal (RFP) process. On June 16, 2011, CMS awarded Provider Resources Inc. with the WCRC contract. The award notice posted by CMS on June 23, 2011 outlines the primary responsibilities … Read moreCMS Awards New WCRC Contract