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CMS Requires Mandatory Medicare Secondary Payer

Jan 15, 2009

CMS Requires Mandatory Medicare Secondary Payer
Reporting as of Jan. 1, 2009

Starting January 1, 2009, group health plans (GHP) must provide reports to the Centers for Medicare and Medicaid Services (CMS) about plan participants who also have Medicare coverage. These reports help CMS coordinate with group health plans whose members have Medicare, thus saving CMS money.

Insurers and third-party administrators are primarily responsible for providing these reports on behalf of the group health plans.  Anthem Blue Cross will provide this reporting on behalf of our groups.

The mandate requires that Anthem Blue Cross provide the following client information:

Why is CMS asking for this information
Anthem Blue Cross already reports most of this information through a voluntary data exchange agreement currently in place with CMS. Beginning January 1, 2009, reporting will be mandatory. The data collected enables CMS to pay claims accurately the first time by determining primary versus secondary payer responsibilities. 

What's the penalty for non-compliance
Failure to report the required eligibility data may subject Anthem Blue Cross and potentially your clients to a civil penalty of $1,000 for each day of noncompliance for each individual for which the information should have been submitted. No fines will be issued as long as groups and carriers make good-faith efforts towards compliance.  

No action on the part of you or your clients is needed at this time. If Anthem Blue Cross requires additional information from your clients in the future, your Regional Sales Manager will contact you with instructions.
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