Notice to Members, Insurance Brokers and other interested parties
Re: Medicare Secondary Payer Mandatory Reporting
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) adds new mandatory reporting requirements for group health plan arrangements and for liability insurance (including selfinsurance), no-fault insurance, and workers’ compensation.
The Medicare User’s Guide states, “By statute, Medicare is secondary to liability insurance (including self-insurance), no-fault insurance, and workers’ compensation.” The Guide continues to say, “The data collected under Section 111 reporting will be used by CMS in processing claims billed to Medicare for reimbursement for items and services furnished to Medicare beneficiaries and for MSP recovery efforts, as appropriate.”
According to the User’s Guide, “Where the applicable law or plan authorizes employers to join with other employers in self-insurance pools (e.g., joint powers authorities) and the self-insurance pool (1) is a separate legal entity (2) with full responsibility to resolve and pay claims using pool funds (3) without involvement of the participating employer, the self-insurance pool is the RRE (Responsible Reporting Entity).”
The Alabama Self-Insured Worker’s Compensation Fund is an RRE and will be reporting claims to Medicare according to Medicare’s established guidelines and procedures. Reporting, according to Medicare’s present timeline, will begin in 2010.