How the Medicare Secondary Payer Reporting Service Works

To participate, simply report claims as usual to ISO ClaimSearch® using Universal Format and notify ISO of the Medicare-eligible claimants. ISO ClaimSearch will automatically forward any claimants/coverages you mark as Medicare-eligible to CMS. ISO ClaimSearch will send the claim reports to CMS according to the schedule for each responsible reporting entity (RRE).

Your company will be able to report and update claims using a system-to-system connection to ISO ClaimSearch or the ISO ClaimSearch web reporting application. The ISO ClaimSearch website will contain all of the data fields CMS requires, and you’ll see an indicator next to those fields that CMS requires for reporting.

How to determine Medicare eligibility (optional service)

To help you identify Medicare-eligible claimants, ISO will provide an optional monthly query of the CMS database for applicable claims that may qualify for CMS reporting. ISO will post the results of the query to the Account Management section of the ISO ClaimSearch website. You can then add the Medicare-eligible indicator to claimants that the system should forward to CMS.

To accept queries to its database, CMS requires certain fields of information on each claim:

  • claimant name
  • Social Security number (SSN) or Health Insurance Claim Number (HICN)
  • gender
  • date of birth

Since your company may have reported claims to ISO ClaimSearch without some of the required fields, ISO will provide, on request, a Pre-Query Extract File of all of your company’s injury claims in the ISO ClaimSearch database.

Data warnings

A warning indicator will appear on outgoing system match reports if any CMS-required fields are missing for a Medicare-eligible claimant. That lets you add required missing information by submitting an update or replacement to the record in the database before the next quarterly reporting date.

CMS acknowledgment and rejection service

ISO will post CMS acknowledgments and rejections to your company’s Account Management page on the ISO ClaimSearch website. If CMS rejects the claim, you can update the claim and resubmit it to ISO ClaimSearch. The system will resubmit the claim to CMS during the next quarterly reporting period.

Append-DSSM service (optional service)

ISO offers Append-DSSM, an optional service that helps you obtain Social Security numbers (SSN) and other public-records information. When you report a claim without a Social Security number, Append-DS automatically triggers a public-records search and includes information found in the Search Results report. Once you get the information you need, you can update the original claim with the missing information and resubmit it to ISO ClaimSearch.

Please note: ISO ClaimSearch will not automatically add the information you retrieve from Append-DS to the claim, store that information in the ISO ClaimSearch database, or send it to CMS. Companies are responsible for using the information to update their claims.

Find out more

For more information, contact the ISO ClaimSearch Electronic Reporting Office at claimsearchmsp@iso.com or call us at 1-800-888-4476.

We look forward to supporting your compliance with CMS rules.

The initial production date for submitting nongroup health plan (NGHP) input files is January 1, 2011. The Centers for Medicare and Medicaid Services (CMS) has delayed required submission of liability insurance (including self-insurance) initial claim reports to the first calendar quarter of 2012 for all liability insurance TPOC (total payment obligation to client) amounts with no ORM (ongoing responsibility for medicals) involvement. Liability insurance (including self-insurance) ORM and nonliability TPOC reporting are not subject to the delay. You should report those claim types starting January 1, 2011. Visit the CMS website for more details.