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Medicare/MMSEA – Defense “Query” of Plaintiff

As we approach the newest start date for Section 111 MMSEA Reporting, many plaintiffs’ attorneys have been approached by defense attorneys with new forms.  These new forms ask for personal information regarding the plaintiff, beneficiary, and even attorneys.   Why?

Under the MMSEA, the defendants have become Responsible Reporting Entities (“RREs”).  This means that they are required to query the Medicare system of the Coordination of Benefits Contractor (“COBC”) to determine if a plaintiff was or is medicare eligible.  RRE penalties for noncompliance will be large.  Keep in mind that Section 111 Reporting was pushed back to October 1, 2010 and January 1, 2011.

So what does the defense really need to query the Medicare systems?

  1. First letter of the beneficiary’s first name;
  2. First six letters of the beneficiary’s last name;
  3. The beneficiary’s gender;
  4. The beneficiary’s date of birth; and,
  5. Either the Health Insurance Claim Number (HIC# or HICN) OR the Social Security Number (SSN).

But note that the COBC and MSPRC prefer the beneficiary’s HIC# over the Social Security Number.

The other information that defendants will request is only necessary upon settlement (these are the “50 Data Points“).  However, at Lien Resolution Services, we believe cooperation is paramount in avoiding settlement delays.  Preparation will become even more important as January 1, 2011 approaches.  Be sure to ask for lien resolution assistance before you settle.

Ryan J. Weiner
Co-Founder Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

One comment on “Medicare/MMSEA – Defense “Query” of Plaintiff

  1. […] an RRE must perform a Medicare “Query” of the plaintiff/beneficiary.  The RRE needs only the following five pieces of […]

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