Medicare Reporting Services

The Vendor is required to provide medicare covered items and services furnished to Medicare beneficiaries. Section 111 reporting helps CMS determine primary versus secondary payer responsibility-that is, which health insurer pays first, which pays second, and so on.
- Must be capable of interfacing with Agency systems through means of flat file import / export or the exchange of data using an API call. The vendor will also need to provide the format including screenshots of how they would like to receive the reporting data from our current File Handler claims system. 
- Special Fund division is soliciting for section 111 MSP reporting services to assist the agency with the reporting requirement through integration with our current special fund claims system, file handler, where all claimant information is housed. 
- The vendor should be familiar with this process and have been conducting this reporting for other entities for a minimum of five years.
- Reporting is accomplished by either the submission of an electronic file of liability, no-fault, and workers' compensation claim information, where the injured party is a medicare beneficiary, or by entry of this claim information directly into a secure web portal, depending on the volume of data to be submitted. 
- Upon receipt of this information, CMS checks whether the injured party associated with the claim report is a medicare beneficiary and determines if the other insurance is primary to medicare. 
- CMS then uses this information in the medicare claims payment process and, if medicare paid first when it should not have, uses it to seek repayment from the other insurer or the medicare beneficiary.

- Contract Period/Term: 5 years