CMS Discusses TPOC/WCMSA Reporting Issues – Webinar Summary

By Jeremy Farquhar, Maureen Burnham, J.D., Kristen Carlson, J.D.

April 23, 2026 / 12 min read

On April 15^th, the Centers for Medicare and Medicaid Services (CMS) held its third TPOC/WCMSA webinar. This webinar was initially scheduled for October 1, 2025, but was postponed (likely due to last fall’s government shutdown) and eventually rescheduled to March 25, 2026. CMS then subsequently rescheduled the event again to April 15^th.

Reporting issues between coworkers

Heading into the webinar, many RREs were likely hopeful (and perhaps expecting) that CMS would discuss specific solutions to certain downstream issues that have developed since TPOC/WCMSA reporting started in April 2025, especially given the considerable amount of time CMS has had to address these items since October 2025, when this session was originally scheduled. However, CMS spent the bulk of this webinar mainly reviewing basic aspects of the Section 111 WCMSA reporting process previously covered. While CMS acknowledged certain downstream issues being experienced by RREs, it stopped short of unveiling any immediate solutions to rectify them, and, instead, referred to unspecified measures it plans to take to mitigate these issues, while placing the onus on RREs to take steps to avoid these issues. In this regard, many RREs likely found the webinar rather limiting and disappointing. One new item of note, as discussed below, CMS will now treat the Professional Administrator (EIN) field “as required” where professional WCMSA administration is utilized.

Summary and areas of concern

The following is a high-level summary of the key points discussed by CMS, along with “areas of concern” as applicable, as follows:

Case Control Number (CCN): This field remains optional. However, CMS noted that failure to provide this information can cause multiple cases to be established (this would only occur in a situation where a WCMSA was submitted to CMS for approval).

Areas of Concern: We list this item for note, as CMS was unclear regarding the potential impact that may result from multiple cases being established. From a practical standpoint, the industry is relying on CMS to use the data provided by the RRE during both the voluntary WCMSA and Section 111 reporting process to create a singular case. If CMS is unable to match a case created via the voluntary WCMSA approval process to a Section 111 report without the CCN, in the authors’ opinion, CMS should seriously consider making the CCN related error a “soft error” [notably, the error returned if an incorrect or invalid Professional Administrator EIN is submitted (CW09) is a soft error] which will not result in an outright rejection of an RRE’s entire coverage report based on a mistake in the reported CCN.^[1]With CMS’s CMPs process now live, RREs are understandably concerned about rejections due to errors, leading to delays in reporting and the potential for assessment of a penalty for untimely reporting. If CMS were to remove that risk by making the CCN related error a “soft error,” RREs would likely be much more willing to attempt to submit a CCN value that CMS has defined as “optional”.

Professional Administrator (EIN): Significantly, CMS noted that this field will now be treated “as required” in scenarios that do involve professional administration (although this field is technically noted as an “optional” field within the Claim Input File layout and will not always be applicable). On this point, CMS noted that it is adjusting system logic to mitigate related issues and that it will be publishing a corresponding User Guide update at some point in the future. However, CMS stated it cannot convert this field to “required” without what it termed as “adverse” impacts to RREs. Presumably, what CMS may be referring to here is that CMS will not be making this field systematically required in the sense that an associated coverage record would be rejected based on the absence of a valid EIN value but is now considering this “as required” when applicable in scenarios involving professional administration. In addition, CMS went on to explain that the issue which was occurring regarding this field caused WCMSAs submitted via the voluntary WCMSA approval process, which had appropriately included valid professional administration information, to have their Professional Administrator EIN value be overlaid with zeros, if this field, clearly defined in CMS’s User Guide simply as “optional,” was not included within the Section 111 report. This then led CMS to treat these MSAs as “self-administered” despite the fact that CMS had clear information to the contrary within the MSA submitted for approval via the voluntary process.

Areas of Concern: This requirement raises several issues for consideration. For example, one may question whether it is an overreach by CMS to mandate an RRE provide the EIN associated with an unrelated entity (e.g., a professional administrator). It is unclear why CMS has not created a post-TPOC process whereby they can obtain the EIN directly from the professional administrator, especially since CMS interacts directly with the professional administrator via the WCMSA administration/attestation process. From a practical perspective, requiring the RRE to provide and report tax ID information connected to an unrelated professional reporting entity's information seemingly shifts this data gathering process to the RRE.

Section 111 MSA values do not match voluntary WCMSA review process values: CMS acknowledged that in situations where there are mismatches between the data submitted via the Section 111 process and the voluntary MSA approval process, CMS will view the information submitted via Section 111 process to be correct and final. In the case of differing information, the WCMSA case will be converted to “non-approved” and, when pending a CMS approval decision, identified as completed and no approval will be issued. This will then prompt a CMS Notice of Settlement (NOS) letter to be mailed out. On this point, CMS noted that it has adjusted its system logic to not include “cents” and a value tolerance to mitigate consequences of exact matching programming, although it did not provide any further details about the specific tolerance values they have reportedly implemented. CMS emphasized that they expect RREs to validate all data to ensure accuracy, consistency and that RREs should check field requirements before reporting.

Areas of Concern: Regarding the Notice of Settlement (NOS), CMS indicated during the Q&A portion of the webinar that they will not issue a corrective NOS if WCMSA data is changed/corrected via section 111 reporting. This may be potentially problematic, as once CMS provides documentation of settlement via the NOS, they may be viewed to be leaving the industry without a path to receiving any documented correction. RREs are in the early days of WCMSA reporting, and corrections have been accepted and processed by CMS. However, where CMS issued the NOS containing incorrect information but does not (and will not) send an updated NOS, there may be concern created amongst parties that there is no means to validate the corrected information. CMS did indicate that they would revisit this approach, and we are hopeful this concern is alleviated.

Voluntary WCMSA case removed from the WCMSA review process: CMS explained that if it receives a TPOC report with a WCMSA, it presumes that the settlement and the WCMSA have been finalized, regardless of the WCMSA submission status at the WCRC. Thus, in this situation, the WCRC will take no further action on the submitted WCMSA. Accordingly, CMS noted that RREs should coordinate with all parties prior to reporting the TPOC and WCMSA data. In the authors’ opinion, what CMS seemed to be driving at here is that RREs need to be very careful not to prematurely report TPOC and WCMSA data before the TPOC and WCMSA are actually finalized.
Settlements with multiple dates of incident: CMS noted that RREs report both the TPOC and MSA information via a single Section 111 report using the earliest resolved date of incident (DOI) along with a complete list of diagnosis codes released/resolved via the settlement including the full TPOC and WCMSA amounts, which aligns with the guidance CMS published last fall in User Guide (Version 8.2) and restated in their latest User Guide (Version 8.4) released last week. During the webinar, CMS attempted to illustrate a systematic MSA related issue which it suggested this guidance could help to mitigate. The example provided involved a single settlement and WCMSA which resolved 23 different DOIs. In this example, through the voluntary WCMSA approval process, this involved a single case and single WCMSA record. However, via the Section 111 reporting process, this same scenario was submitted via 23 separate coverage records (one for each DOI) and resulted in the creation of 23 individual WCMSA cases, leading to complications with the records used for coordination of benefits purposes.
Single settlement involving multiple defendants contributing to a TPOC and MSA: During the Q&A segment of the webinar, an attendee asked if each defendant party/RRE should be reporting the full overarching settlement/TPOC and MSA amounts reflecting the contributions of all involved parties or if each defendant party/RRE should only be reporting their individual contributions/proportionate shares. In response, CMS reiterated its longstanding guidance that if the defendants/RREs are “jointly and severally” liable, then each defendant party/RRE reports the full overarching TPOC amount reflecting the contributions of all defendants/RREs. Conversely, if joint and several liability is not applicable, then each defendant/RRE simply reports their own contribution to/proportionate share of the TPOC. As for reporting the MSA amount, the CMS presenter provided guidance that appeared to contradict CMS’s instructions as stated in the newly published User Guide (Version 8.4). Specifically, the CMS presenter advised that the MSA would be reported similarly to how the TPOC would get reported as stated above. However, per CMS’s new User Guide (Version 8.4) update, each RRE would actually report the full overarching MSA Amount – and they would report the full MSA amount, regardless of the amount it contributed to the WCMSA and regardless of how the TPOC gets reported. Regarding this discrepancy, as CMS notes at the beginning of every webinar, CMS’s published guidance controls in situations where their comments on a webinar contradict their written guidance.
Changing a WCMSA approved as a structured settlement to lump sum at time of settlement: Also as a part of the Q&A segment of the webinar, an attendee asked CMS, if subsequent to the MSA being approved via CMS’s voluntary approval process the decision was made to fund the MSA as a lump sum as opposed to a structured settlement/annuity, where the approved MSA had noted funding via structured settlement/annuity, could the updated funding method simply be reported via the Section 111 process or would additional action be necessary? In response, CMS indicated that, if/when this occurs, it would be necessary to follow up with the WCRC to ensure that the prior approval is updated to reflect the desired change from structured settlement/annuity funding to lump sum. Once that occurs, CMS noted that the RRE should report the MSA via the Section 111 process as a lump sum, which should then be consistent with the information connected to the approved MSA. From the authors’ perspective, this feedback is worth highlighting as this is not something that CMS has addressed directly via their published Section 111 reporting guidance and therefore many RREs may be unaware of this expectation.

Areas of Concern: From the author’s perspective, this may be another area of consideration for CMS, as the method of funding is frequently a negotiation point within a settlement. The concern associated with this process is timeline driven. If an MSA is CMS approved prior to settlement via the voluntary process, however, the method of funding is adjusted prior to finalizing settlement, current process is that the submitter must request and gain WCRC approval of a change in the method of funding prior to settlement. If the expectation is that this process continues in addition to the Section 111 process it seems impractical to ask that all parties delay final settlement to request approval via the voluntary process for an adjusted funding method when CMS has indicated the WCMSA data collected via the Section 111 process is presumed to be validated by the RRE prior to reporting. Requiring parties to revert to the voluntary process when the approved MSA amount remains the same and only the method of funding has changed adds time and effort to the pre-settlement process when CMS will collect that funding change as part of the streamlined WCMSA Section 111 reporting process at TPOC.

CMS’s outlines Section 111 WCMSA Reporting “Best Practices”

CMS outlined several “reporting best practices.” In this regard, CMS recommends that the parties cooperate to make sure the information reported to CMS is accurate and complete and that MSA data only be reported once a settlement has occurred. CMS also reminded the attendees that all fields should be populated, as applicable, and that while certain fields may be considered “optional,” failure to populate those fields when applicable will lead to issues in CMS’s systems that may negatively impact the beneficiary and other involved parties.

Going forward, it will be interesting to see if CMS will continue to host webinars on its TPOC/WCMSA process to discuss what steps CMS may take to address the outstanding issues addressed above and provide additional insight into the data they have collected.

How Verisk can help

Since CMS announced its intention to collect WCMSA data via Section 111 reporting, we have identified gaps in the process and developed ways to make the required reporting as easy, seamless, and accurate as possible. A few key features of our solutions are:

Easy identification of MSA data fields: Our MSA reports highlight the data that CMS is collecting through Section 111 for quick and easy identification. Additionally, our email delivery of the completed MSA report includes all the relevant MSA data fields and elements.
Proposed settlement language addressing WCMSA: When used, this helps to ensure that all parties to the settlement are advised of the WCMSA and administration approach. Additionally, this makes it clear what fields should be entered into the WCMSA fields for Section 111 reporting.
Accurate reporting: We alert to missing WCMSA data and ensure data is populated prior to Section 111 reporting. We also create alerts for common data input errors (ex: WCMSA amount is greater than the TPOC amount).
Apply Section 111 Data Sync to your program: Make sure that incorrect WCMSA data is not reported to CMS. Whenever WCMSA data is entered, Verisk will automatically compare these fields to our database to ensure that what is entered matches the settlement documentation or MSA we have on record for the claim. The adjuster is automatically alerted to a potential discrepancy and with the click of a button the data is updated within our Section 111 reporting system.
Customized reports: Our MSP Navigator Section 111 reporting platform has a built-in dashboard with robust report and analytics capabilities, enabling users to quickly review their Section 111 WCMSA data and pull customized reports to evaluate compliance and gaps.

Questions?

Please contact the authors if you have any questions regarding the above or how Verisk can help you address TPOC/WCMSA reporting.

[1] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter V, Appendix F.