Section 111 NGHP User Guide Version 4.3, Revised to Implement Eight Change...
According to the Revision History, Version 4.3 of the NGHP User Guide applies more changes than any other update in the 5+ years since Version 1.0 was published. A majority of the changes are...
View ArticleVisit MEDVAL Next Month at the National Workers’ Compensation and Disability...
The NWCDC is rapidly approaching! November 19-21, 2014, marks the 23rd anniversary of this event which is to be held at the Mandalay Bay Convention Center for the second straight year. For more...
View ArticleMMSEA Section 111 Alert: CMS to Allow NGHP RREs to Designate a Medicare...
The current “TPA workaround” method of identifying a third party administrator on TIN Reference files is being eliminated. CMS has announced that effective 07/13/15, NGHP RREs will have the option to...
View ArticleUpdates Added to the WCMSA Reference Guide
CMS issued an alert today that a revised version of the WCMSA reference guide has been released. The revised guide, dated January 5, 2015, can be found here. CMS also issued a revised...
View ArticleCMS Releases MMSEA Section 111 NGHP User Guide Version 4.4
CMS released an updated NGHP User Guide, Version 4.4, dated January 5, 2015. The primary changes include: The TPOC Liability Claim Report Rejection code CJO7 changed in definition so that cumulative...
View ArticleFormal Appeal Rights for Conditional Payments for Applicable Plans
For Medicare Secondary Payer (MSP) recovery demand letters issued on or after April 28, 2015 to liability insurance (including self-insurance), no-fault insurance, or a workers’ compensation entity as...
View ArticleCMS Webinar: Appeal Rights for Applicable Plans
On Tuesday, May 5, 2015, CMS presented a webinar on the Appeal Rights for Applicable Plans. The final rule establishing a formal appeals process for applicable plans in situations where Medicare...
View ArticleEstablishing Appeal Rights for Applicable Plans – Presentation Now Available
CMS has posted the slides from the May 5, 2015 webinar regarding the Appeals Rights for Applicable Plans. The presentation, entitled “Applicable Plan” Appeals: Appealing a Medicare Secondary Payer...
View ArticleMulti-Factor Authentication (MFA) coming soon on the Medicare Secondary Payer...
The Centers for Medicare & Medicaid Services (CMS) will be implementing optional Multi-factor Authentication (MFA) services on the Medicare Secondary Payer Portal (MSPRP). This change is being made...
View ArticleNGHP MMSEA Section 111 User Guide Version 4.7 Released
In their fourth update this year, CMS applied four change requests to Version 4.7 of the NGHP MMSEA Section 111 User Guide. All changes incorporated information published in prior Alerts. Within...
View ArticleEnhanced Functionality and Other Changes to the Medicare Secondary Payer...
As of January 1, 2016, the Medicare Secondary Payer Recovery Portal (MSPRP) now includes functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an...
View ArticleCMS May Finally Be Forced to Address Medicare Appeal Backlog
On Tuesday, February 9, 2016, the U.S. Court of Appeals for the District of Columbia overturned the December 2014 dismissal of a suit by the American Hospital Association against DHHS for unreasonable...
View ArticleCMS Admits to Backlog Due to Commercial Repayment Center Non-Group Health...
On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) released an Alert regarding the status of the transition of Non-Group Health Plan (NGHP) recovery activity from the Benefits...
View ArticleNew WCRC RFP Announced
On February 22, 2016, CMS announced that it anticipates releasing the WCRC solicitation [Solicitation No: RFP-CMS-2016-8A-0008] on or about March 8th with a bid deadline on April 8th and anticipated...
View ArticleFDA to Require Black Box Warning on All Immediate-Release Opioid Medications
On Tuesday, March 22, 2016, the U.S. Food and Drug Administration (FDA) announced it will now require a black box warning on all immediate-release opioid medications. This warning will address issues...
View ArticleCMS to Begin Utilizing 2011 Life Table
CMS has yet to issue a notification or alert regarding use of an updated life table. However, the CMS WCMSA web portal, where we upload our CMS submissions, has alerted authorized web portal users...
View ArticleFinal Rule Regarding Expansion of the Functionality of the Medicare Secondary...
On May 17, 2016, The Centers for Medicare and Medicaid Services (CMS) released the final rule, specifying the timeline and process for expansion of the current Medicare Secondary Payer Recovery Portal....
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Finally, June 27
Today is June 27, the first day indicated by CMS as the target date CMS anticipated releasing the adjusted solicitation for the new Workers’ Compensation Review Contractor (WCRC). We, at MEDVAL, are...
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A Reminder that there is no MSP Reimbursement Obligation Until CMS Makes a...
While always entertained by pro se plaintiffs who take on the man, an interesting MSP opinion came out of the Eastern District of NY on July 11, 2016. Upon receipt of a conditional payment letter,...
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MSPA Claims 1, LLC cases Remanded Back to State Court
In the ongoing pursuit of PIP reimbursements with double damages under the Medicare Secondary Payer Act, two MSPA Claims 1 cases have been remanded back to state court. Because early cases failed in...
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