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New Provisions For Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers' Compensation, found at 42. U.S.C. 1395y(b)(8) Section 111 adds reporting rules; it does not eliminate any existing statutory provisions or regulations. The new provisions do not eliminate CMS' existing processes if a Medicare beneficiary (or his/her representative) wishes to obtain interim conditional payment amount information prior to a settlement, judgment, award, or other payment. - It includes penalties for noncompliance.
- Who Must Report: "an applicable plan." , "...[T]he term 'applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan, or arrangement: (i) Liability insurance (including self-insurance). (ii) No fault insurance. (iii) workers' compensation laws or plans."
- What Must Be Reported: The identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue as well as such other information specified by the Secretary to enable an appropriate determination concerning coordination of benefits, including any applicable recovery claim.
- Data elements determined by the Secretary.
- When/How Reporting Must be Done:
- In a form and manner, including frequency, specified by the Secretary.
- Information shall be submitted within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).
- Submissions will be in an electronic format.
Use of Agents: The applicable NGHP RRE may contract with an entity to act as an agent for reporting purposes. Agents may include, but are not limited to, data service companies, consulting companies or similar entities that can create and submit Section 111 files to the COBC on behalf of the RRE. An RRE may not shift its Section 111 reporting responsibility to an agent, by contract or otherwise. The RRE remains solely responsible and accountable for complying with CMS instructions for implementing Section 111 and for the accuracy of data submitted.
| Downloads | MMSEA 111 - Quick Reference Guide Version 1.0 - January 19, 2012 - For Non-Group Health Plans (NGHP) Insurers [PDF 96KB]
MMSEA 111 - December 16, 2011 -User Guide - Liability Insurance (Including Self-Insurance), No-Fault Insurance and Workers' Compensation User Guide, Version 3.3 [PDF 1.12MB]
MMSEA 111 - October 14, 2011 - 2011 NGHP Notice and Agenda [PDF 39.85KB]
MMSEA 111 - Revised - July, 2011 - 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting NGHP Entities, Version 5.0 [PDF 116.70KB]
MMSEA 111 - February 7, 2011 - Alert For Foreign Insurers [PDF 46.64KB]
MMSEA 111 - Revised - March 29, 2010 - Quick Reference Guide for Section 111 Registration For All Responsible Reporting Entities [PDF 246KB
MMSEA111 - August 24, 2009 - HICN, SSN Collection - NGHP Model Language [PDF 68.63KB]
MMSEA111 - May 26, 2009 - Compliance Guide Regarding Obtaining Individual HICNs and/or SSNs for Non-Group Health Plan (NGHP) Reporting [PDF 68.63KB]
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Page Last Modified: 01/24/2012 3:35:52 PM
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