Medicare Reporting Services

The Vendor is required to provide designated reporting agent and comply with section 111 of the medicare, medicaid, and insurance program extension act of 2007 non-group health plan mandatory reporting process.
- Must perform data exchange with the County’s workers’ compensation system of record: Riskonnect (formerly Ventiv) Claims Enterprise (“iVOS”) software, the Coordination of Benefits & Recovery (COB&R), and the Benefits Coordination & Recovery Center (BCRC).
- Process and validate data produced by iVOS for section 111 reporting.
- Act as the county’s designated reporting agent and perform claim information data exchange with the BCRC in accordance with section 111 reporting.
- Process data for section 111 reporting without affecting the performance capability of iVOS.
- Notify the county of missing or incomplete data on reportable claims prior to section 111 file submission and provide the county a minimum of three (3) business days to correct the error.
- Notify the county of data validation error(s) prior to section 111 file submission and, as needed, correct any errors and/or provide guidance on correcting the error(s).
- Notify the county of potential compliance issues as discovered and present a recommended plan of action.
- Comply with the county’s section 111 designated reporting timeframes (the 22nd – 28th of February, May, August, and November)
- Inform the county of regulatory and case law updates.
- Provide data analytics to the county upon request.
- Provide training and training materials to applicable county staff.
- Identify claims through section 111 query to initiate conditional payment service and seek medicare authorization if applicable.
- Request a conditional payment letter from medicare, review the listed charges, and provide recommendations regarding potential conditional payment disputes.
- Submit a dispute on behalf of the county to the CRC prior to them issuing a medicare demand letter.
- Follow the dispute to resolution.
- Provide a lien dispute protocol.
- Provide medicare set-aside and medical allocation services and reporting to include strategies to reduce costs.
- Medicare set-aside proposal on behalf of the county, oversee follow-up, and provide rebuttal if medicare disagrees.
- Provide training or educational meetings to the county.
- Provide customer service support. 
- Services shall include, but are not limited to, responding to inquiries from county staff regarding reporting obligations, claim submissions, data discrepancies, and compliance issues within one (1) business day. 
- Escalate issues to obtain answers as necessary. 
- Ensure availability during regular county business hours, Monday through Friday, from 8:00 a.m. to 5:00 p.m., excluding county holidays, possess thorough knowledge of section 111 reporting processes, and demonstrate experience in handling sensitive personal and medical data in accordance with HIPAA and other applicable privacy regulations.
- Contract Period/Term: 1 year
- Pre-Proposal Conference Date: July 3, 2025
- Questions/Inquires Deadline: July 18, 2025