Pre-Query Extract File Process

To participate in the ISO ClaimSearch Medicare Secondary Payer Reporting Service, your company must notify ISO ClaimSearch of all pending claims that involve Medicare-eligible claimants.

To help you identify which claimants are Medicare-eligible, each month ISO ClaimSearch will query your submitted claims automatically against the CMS Medicare Eligibility database. The query requires ISO ClaimSearch to include these fields 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, an extract file of all of your company's injury claims in the ISO ClaimSearch database.

That file will help you identify:

  • closed claims that you don't need to report to CMS
  • open claims that you should query against the CMS database to identify Medicare-eligible claimants
  • claims missing some or all of the data elements CMS requires for queries or reports
  • the format of the claim report your company submitted to ISO ClaimSearch (legacy or Universal Format)

Note: The system can query both legacy and Universal Format claim reports, but you may only report Universal Format claims to CMS. You will need to convert all claims in legacy format to Universal Format before you can forward them to CMS.

How the process works

  1. The pre-query extract file will contain all of your company's injury claims, including the identifying fields, such as claim number, policy number, date of loss, and claimant name
  2. The file will identify whether your company submitted the claim as a legacy claim or in Universal Format.
  3. The file will reveal whether claims have the data fields CMS requires to perform the query (Social Security number (SSN) or Health Insurance Claim Number (HICN), gender, date of birth)
  4. The file will indicate if your company reported a closed status and closed date. ISO ClaimSearch will query only open claims within the look-back periods that CMS defines.
  5. The file will indicate if the claim type meets CMS reporting criteria. The system will query and report on workers' compensation, no-fault (by CMS definition) and liability claims.
  6. After you receive the file, your company can update it with the necessary information and return it to ISO ClaimSearch before the system performs the CMS query.

Note: If your company will report to CMS using multiple Responsible Reporting Entity (RRE) codes, you will need to indicate the applicable RRE code for each claim.

Additional information on the extract file layout is available at https://claimsearch.iso.com/ in the User Manuals and Guides section. You will need your ISO ClaimSearch user ID and password to access the file layout.

Find out more

If you have questions about the service, please call or call us at 1-800-888-4476 and ask for the ISO ClaimSearch Account Management Team. Or send an e-mail message to claimsearch.sales@iso.com