Medicare Secondary Payer Mandatory Reporting

Medicare is a secondary payer to group health plan coverage, liability insurance, no-fault insurance, and workers compensation. In 2007, the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) was created to help Medicare process claims billed to Medicare for payment and for recovery efforts of claims paid in error.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), requires liability insurance (including self-insurance), no-fault insurance, or workers compensation to report Medicare beneficiaries who receive settlements, judgments, awards or other payments. Workforce Safety & Insurance (WSI) is considered a Responsible Reporting Entity (RRE) and will report all Medicare beneficiaries who receive workers compensation claim awards or payments for the state of North Dakota beginning April – June calendar quarter of 2010.

The Center for Medicare & Medicaid Services (CMS) will implement the reporting requirements for Section 111. For more information on the issue, go to: www.cms.hhs.gov/MandatoryInsRep