Claims Solutions

Medicare Compliance and Reporting Solutions

Efficiently navigate the evolving changes of Medicare compliance and better manage complex recovery demands with a range of best-in-class solutions that support you throughout every step of the claims journey.

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Keep up with Medicare compliance and achieve accurate, timely reporting

Build comprehensive, holistic Medicare reporting solutions. Help reduce your exposure to risk and enhance adherence to Medicare compliance with our extensive suite of leading tools and expert services for Section 111 mandatory reporting, Medicare conditional payment resolution, and future medical allocations compliance.

Keep up with Medicare compliance and achieve accurate, timely reporting

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Section 111 mandatory reporting solutions

Easily meet your reporting obligations while laying the groundwork for a strong program to address MSP compliance with a holistic approach using our robust CMS reporting solution and review services. Leverage our expertise and data-driven insights to prepare accurate submissions in less time and streamline your compliance process.

Streamline Section 111 reporting

Proactively handle compliance and ensure error-free submissions to CMS with advanced analytical and smart reporting capabilities.

Learn about MSP Navigator

Conditional payment lien resolution solutions

Depend on our experts to challenge inappropriate or unrelated Medicare demands, preventing overpayment of conditional payment liens and reducing risk of Treasury collections.

Overcome MSP compliance limitations

Reduce risk and achieve full MSP compliance by streamlining payment process.

Learn about CP Link

Pay only what you owe for Medicare conditional payments

Eliminate risk and exposure while ensuring resolution of more claims with a comprehensive, advocate-driven approach to conditional payment disputes.

Learn about Conditional Payment Dispute and Appeal Services

Avoid collections and resolve Treasury claims

Work with a team of conditional payment experts to avoid U.S. Treasury Department collections and resolve any Treasury claims and offsets that arise.

Learn about Treasury Compliance

Medicaid compliance and recovery services

Protect your bottom line and ensure full Medicaid compliance with recovery claims. Trust our experts to help resolve Medicaid recovery claims in any state.

Learn about Medicaid Compliance Services

Future allocation solutions

You can cut costs, optimize settlements, and stay compliant working with a CMS compliance team and nurse practitioners who accurately determine future medical costs.

Comply with Medicare's requirements with confidence

Improve your Medicare compliance for future medical allocations while managing expenses with an advocacy-driven approach.

Learn about Medicare Set-Aside Allocation

Build a cost-mitigation strategy

Leverage our industry-leading clinical and legal expertise to achieve MSA savings through experience, advocacy, and innovation.

Learn about Provider Outreach Cost Mitigation

Make Amended Review work for you

Maximize your one chance at obtaining an Amended Review from CMS—and gain savings for eligible claims.

Learn about MSA Second Look

Get the most accurate estimate of claim exposure

Leverage our nurses’ vast clinical and insurance experience to accurately assess future medical cost exposure for reserves and settlement analysis.

Learn about Medical Cost Projection

Benchmark Report 2025

Average TPOC in Medicare-involved liability settlements rose 27% more than the Consumer Price Index between 2018 and 2024. Find out why.

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Benchmark Report 2025

Meeting the MSP Challenge

MSP compliance presents a unique set of challenges. Discover how setting a strong upfront strategy can help you succeed.

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Meeting the MSP Challenge

Boost compliance using an unmatched expert team of more than 40 Medicare compliance attorneys, industry insiders from the Treasury Department and CMS, and nurses with extensive cost mitigation backgrounds.

Consult with our experts

Discover Verisk's robust claim insights and compliance support

Our proven compliance solutions empower your team.

Discover Verisk's robust claim insights and compliance support

Related resources

Stay up to date on the latest news and developments in the fast-changing world of Medicare.

Resources

Navigate Section 111 Penalties 'Final Rule’ with Confidence

CMS Section 111 'final rule' has generated a lot of interest. Insurers need to understand the penalty provisions in the new rule to avoid possible fines.

View the resources

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Medicare 2025 Watch List Navigating a New Medicare Compliance Landscape

Download the Medicare 2025 Watch List report and get a deep dive into the recent CMS updates and what to expect in the year ahead.

Download the report

Article

CMS’s Section 111 Penalties “Final Rule” Released – Breaking Down CMS’s Penalty Provisions and How They Impact Section 111 Reporting

In an important development, CMS has released its Section 111 penalties “Final Rule” --- CMS penalties will go live in 60 days.

Read the article

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Do more with the Verisk ecosystem

Streamline claims handling with our full suite of solutions that provide compliance, reporting, and decision support tools and services.

Conquer complex workers' compensation claims challenges

Streamline workers' comp data reporting and improve compliance with advanced analytics.

Learn about Workers' Comp State Reporting

Master workers' compensation data compliance reporting for insurers

Streamline and simplify workers' comp regulatory reporting with a single daily data feed. Insurers save time and improve accuracy with our suite of compliance reporting solutions.

Learn about wcPrism

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Identify severity faster with predictive analytics

Leverage AI and predictive analytics to quickly determine claim severity, improve triage, and control costs throughout the claims cycle.

Learn about wcNavigator

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Improve injury claims outcomes

Achieve consistent and accurate injury evaluations with data-driven insights for fast, fair, and cost-effective resolutions.

Learn about Liability Navigator

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Slash time and spend with AI-powered record review

Expedite record review with fast, accurate extraction of key medical information from unstructured documents. AI automation tools deliver accurate, impartial reviews of every file, helping you settle more claims while conserving time and resources.

Learn about Discovery Navigator

Contact us to learn more

We are available Monday through Friday, 7 a.m. — 8 p.m. US Eastern Time:

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Note that password resets and user information are not available through Live Chat or Email. Instead, please call the main toll-free number below.

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1-800-888-4476

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International Access code, then 800 48977489
When calling from the UK, please dial 00 800 4897 7489

Refer a file

We offer easy access via our online form but can accommodate e-mail, fax, mail, or arrange a pickup from your office. Contact your local sales representative or e-mail us at referrals@verisk.com.

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