Medicare Secondary Payer (MSP) NGHP Reporting Entities CMS Update Alert

CMS: NGHP Responsible Reporting Entities (RREs) that both Med Pay and
Personal Injury Protection (PIP) coverage should be included when reporting the No-Fault Insurance Limit (Field 61 of Claim Input File). As such, NGHP RREs must combine both Med Pay and PIP coverage limits for a policy when they are separate coverages being paid out on claims for the same injured party and incident under a single policy.

Health plans must continue to innovate claim systems and recovery modules, incorporating the OHI and MARx weekly and monthly update files into their claim mining Third Party Liability software.

https://www.cms.gov/files/document/alert-reporting-no-fault-insurance-limit-non-group-health-plan-nghp-claim-input-files.pdf

Third Circuit Appeals Court slams the door on Plaintiffs attempt to allocate settlement

Third Circuit Appeals Court slams the door on Plaintiffs attempt to allocate settlement.

The Third Circuit court of appeals today expressly held that even though Plaintiffs counsel had received from a state court Judge a zero allocation of a settlement to Medicare’s conditional payment. Medicare none the less had a right to its Conditional payment under the MSP regulations.