TPOC/WCMSA Reporting is Underway – Unexpected Issues and Considerations

July 14, 2025 / 8 min read

As many are aware, the Centers for Medicare and Medicaid’s (CMS’s) new Section 111 TPOC/WCMSA reporting requirements started April 4, 2025. As a brief refresher, CMS’s new policy requires workers’ compensation (WC) Responsible Reporting Entities (RREs) to report several different Workers’ Compensation Medicare Set-Aside (WCMSA) data points regarding workers’ compensation settlements with Medicare beneficiaries.

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Specifically, under CMS’s new process RREs must report the following five data points for all WC settlements with Medicare beneficiaries as part of the Medicare Section 111 TPOC reporting trigger: (a) MSA Amount, (b) MSA Period, (c) Lump Sum or Structured/Annuity Payout Indicator, (d) Initial Deposit Amount, and (e) Anniversary (Annual) Deposit Amount. CMS is also collecting the Case Control Number and Professional Administer EIN but these are optional fields.^[1]As noted above, CMS’s new reporting requirement started April 4, 2025, and is prospective in nature, meaning that the reportable WCMSA data points will apply for coverage reports with TPOC dates of April 4, 2025, or later.^[2]

With TPOC/WCMSA underway, we are starting to get our first glimpses of how this is actually working in terms of CMS activity. Based on our handling of MSP claims for our customers and observations thus far, we note the items of likely interest below, along with certain considerations and issues where further CMS clarity may be helpful for RREs reporting WC TPOC going forward:

1. CMS is sending its WCMSA beneficiary letters to both the claimant and RRE.

As part of its roll-out of the new TPOC/WCMSA reporting requirements, CMS advised the industry that it will be sending WCMSA acknowledgement letters to the claimant, with this letter outlining CMS’s expectations related to the use of the MSA funds.

While CMS is sending these letters to the claimant (as the agency indicated it would), we are observing that this letter is also being sent to the RRE. This immediately raised the issue of whether CMS expects the RRE to do anything with these letters. Per Verisk’s contact with the Medicare Benefits Coordination & Recovery Center (BCRC), we have been advised that these letters are for the claimant, the copy being sent to the RRE is simply an “FYI” and that no RRE action is expected.

Compliance considerations: While CMS does not expect the RRE to take any action, the RRE should consider verifying the WCMSA data that was reported through the Section 111 TPOC is accurate. As we have recently started to see, a discrepancy in the Section 111 MSA data may unexpectantly prompt the Workers’ Compensation Review Contractor (WCRC) to alter the MSA approval status.

2. BCRC EDI representatives may contact an RRE if a TPOC is reported while an MSA is currently pending CMS approval.

Based on our recent experience, it appears that when the WCRC receives notice that a TPOC report has occurred while an MSA is pending review, it advises the BCRC to reach out to the RRE to verify the data. It is critical to note that the WCRC may also close the MSA submission when a TPOC report is received.

Compliance considerations: Depending on the circumstances of the claim and settlement, the Section 111 TPOC/MSA reporting may be correct and once the EDI representative is notified, the pending voluntary submission will be closed as a result. However, if the TPOC was reported prematurely while awaiting the results of the MSA submission for approval, additional steps may be required to resolve the issue and avoid a premature closure of the pending submission. Generally, if TPOC is reported when appropriate and applicable in accordance with CMS guidelines, this issue should not arise. RREs should be especially mindful of indemnity only settlements (these should not be reported per CMS’s longstanding Section 111 reporting guidance) or accidently reporting TPOC via Section 111 while a settlement is pending.

3. The WCRC closed a pending MSA submission after TPOC was reported with a $0 MSA amount.

Based on our handling of MSP claims for our customers and observations thus far, the WCRC automatically closed a pending MSA submission for approval based on its receipt of a Section 111 TPOC record indicating a $0 MSA amount. We were not notified by CMS or the WCRC when the MSA submission for approval case was closed. Instead, we were only made aware of the closure after we contacted the WCRC for a status of the pending review.

Compliance considerations: Automatic closures of pending MSA submissions without notice is a significant issue that may lead to potential delays in the MSA review and settlement process. CMS has not provided any clear direction related to how to fix this issue. Presently, we have been reviewing and updating (if appropriate) the Section 111 reporting data, while simultaneously working through the WCRC to reopen the MSA submission for approval.

4. The WCRC converted an “approved” MSA to a “non-approved” MSA status after TPOC reported with an MSA amount less than the CMS approved value.

In this situation, we found that the CMS system is automatically switching the MSA approval status when the Section 111 reported MSA data does not align with the CMS approved MSA amount on file. We have not yet confirmed whether the conversion is solely tied to a discrepancy in the MSA Amount or if discrepancies in other fields, such as the Lump Sum or Structured/Annuity Payout Indicator (funding method) or the Initial Deposit Amount (seed/annuity amount), will trigger a change in status as well.

Compliance considerations: We think CMS should re-evaluate how and when this may occur. Overturning a prior MSA approval without prior notice to the RRE and beneficiary can have serious consequences post-settlement. Additionally, through recent contact with the CMS regional office, if this occurs, the only way to correct the issue is to amend the Section 111 MSA/TPOC reporting to align with the approved amount. It likely also requires close coordination with the WCRC to ensure the system properly switches the non-approved status back to an approved MSA status once the correct Section 111 data is received and processed.

5. The WCRC converted a professional administrative designation to self-administration based on the TPOC MSA data.

In a similar situation, the WCRC converted the administration status of an approved MSA even though a copy of the settlement contract was previously submitted to CMS affirming that the MSA funds would be professionally administered. The conversion appears to be related to the optional Section 111 Professional Administrator EIN field having been submitted with a blank/null value. In the big picture, this action is interesting since the Professional Administrator EIN field is “optional” as part of the CMS Section 111 TPOC/WCMSA reporting requirements.

Compliance considerations: We believe that CMS should reconsider the use of data from an optional Section 111 reporting field to automatically change the MSA administration status. We have contacted CMS to discuss this issue further. In the meantime, it is important to note that there has not been any change to the “Professional Administrator EIN” field, which remains an optional field and therefore providing an EIN is not required for compliance with Section 111 WC TPOC reporting.

Big picture & Verisk activity

Overall, we are deeply concerned that CMS did not provide any public notice that it would be taking the type of actions related to the Section 111 MSA data as outlined above. For obvious reasons, the premature closing of pending MSA submissions, the automatic conversion of approved MSAs to non-approved MSAs, the conversion of Professional Administration to Self-Administration, and the unexpected outreaches by an EDI representative to investigate discrepancies on a case-by-case basis can significantly impact not only the beneficiary but also claims handling and the settlement process.

In response, Verisk has taken several actions. To date, we have contacted the CMS central office, the BCRC, and the WCRC to address these issues from both a case and policy perspective. We have also asked CMS to formally address these actions and to advise MSP stakeholders the best path to managing and resolving these unexpected issues. Thus far, we have not been provided any clear guidance; however, we were advised that some of these issues are unintended consequences of system updates intended to link the Section 111 and MSA systems data and that the agency is looking into improvements and fixes.

In the meantime, ensuring alignment of your Section 111 MSA data with the MSA submission for approval process is probably the best way to proactively mitigate these issues.

How Verisk can help

Ever since the announcement of CMS’s intention to collect MSA data via Section 111 reporting, we immediately tried to anticipate gaps in the process and developed ways to make WC reporting as easy, seamless, and accurate as possible. A few key features of our MSA program and custom 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.
Automated Technology: We created DataSync - an automated solution which combines OCR technology with our custom designed AI models to scan and review settlement documents and identifies and extracts the relevant MSA data fields for reporting. The extracted data can then be validated, mapped, and imported for Section 111 reporting.
Single Source Advantage: For customers that utilize both our Section 111 reporting and MSA services we have the capability to bridge the data for importing and reporting through our MSP Navigator platform.
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 data and pull customized reports to evaluate compliance and gaps.

Questions?

Please do not hesitate to contact the authors if you have any questions or if you would like to learn more about our solutions.

For additional information on TPOC/WCMSA reporting, please see our reporting resource center.

Learn more

[1] CMS’s TPOC/WCMSA Webinar, April 16, 2024. See also, CMS’s Section 111 NGHP User Guide (Version 8.1, May 5, 2025), Chapter V, Appendix A.

[2] See, CMS’s Section 111 NGHP User Guide (Version 8.1, May 5, 2025), Chapter III, Section 6.5.1.1. As part of this section, CMS states, in pertinent part, “For workers’ compensation records submitted on a production file with a TPOC date on or after April 4, 2025, Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) must be reported.” Id. See also, CMS Alert (February 23, 2024), Medicare Secondary Payer (MSP) Mandatory Reporting Provisions Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSES) of 2007, Technical Change Alert: Change to Workers’ Compensation Reporting. See, CMS’s February 23, 2024 Alert.