Mandatory Insurer Reporting
Mandatory Insurer Reporting is when an RRE electronically transmits a claim data file to the COBC. The COBC processes the data in this input file by first editing the incoming data and then determines whether the submitted information identifies the injured party as a Medicare beneficiary.
Other insurance information for Medicare beneficiaries derived from the input file is posted to other CMS databases by the COBC. This is then used by other Medicare contractors for claims processing to make sure Medicare pays secondary when appropriate and/or is passed to the CMS Medicare Secondary Payer Recovery Contractor (MSPRC) for recovery efforts. When this processing is completed or the prescribed time for response file generation has elapsed, the COBC electronically transmits a response file back to the RRE. The response file will include information on any errors found, disposition codes that indicate the results of processing, and MSP information as prescribed by the response file format.
RREs must implement a procedure in their claims review process to determine whether an injured party is a Medicare beneficiary and gather the information necessary for Section 111 reporting. Either the Social Security Number (SSN) or Medicare Health Insurance Claim Number (HICN) must be included on Section 111 record submissions for each injured party.
The CMS is allowing RREs to submit a query to the COBC to determine Medicare status of the injured party prior to submitting claim information for Section 111 reporting. This query will assist the RRE in determining whether the claim must be reported under Section 111.
