Casualty Solutions

5/3/2023 - 6 min read

CMS releases Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide (Version 1.0)

The Centers for Medicare and Medicaid Services (CMS) has released a Non-Group Health Plan (NGHP) Applicable Appeals Reference Guide (Version 1.0, April 27, 2023).

5/1/2023 - 10 min read

CMS’s Query Process and non-binary/unspecified gender designations – current issues and considerations

Section 111 non-group health plan (RREs) involves the inability to submit non-binary or unspecified gender designations as part of the (CMS’s)

4/26/2023 - 18 min read

The Eleventh Circuit dismisses a Medicare Advantage “double damages” lawsuit – court rules the MSP statute does not preempt insurer's claims-filing deadline or Florida’s no-fault pre-suit demand

In a recent Medicare Advantage recovery action, the United States Eleventh Circuit Court of Appeals in MSP Recovery Claims.

4/26/2023 - 1 min read

Starting April 29, 2023, CMS Will Use the 2020 CDC Life Table for WCMSAs

The (CMS) has announced that beginning April 29, 2023, it will use the new 2020 CDC Life Table to calculate adjusted life expectancies in (WCMSAs).

4/25/2023 - 3 min read

CMS releases Section 111 NGHP User Guide (Version 7.1, April 24, 2023)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 NGHP User Guide (Version 7.1, April 24, 2023)

4/25/2023 - 17 min read

Second Circuit dismisses Medicare Advantage “double damages” lawsuit on standing grounds – rules the insurer’s Section 111 reporting did not establish liability

In an interesting new Medicare Advantage recovery decision, the United States Second Circuit Court of Appeals in MSP Recovery Claims.

3/31/2023 - 12 min read

Changing of the Guard: Detail Claim Information (DCI) is sunsetting and the Indemnity Data Call (IDC) will take over – what you should know

The DCI is now scheduled to sunset at the end of December 2023 and is being replaced by the Indemnity Data Call (IDC).

3/29/2023 - 9 min read

Florida (and other states) take aim at regulating Third-Party Litigation Funding

With the state legislative season in full-swing, Florida, along with several other states, has introduced legislation focused on regulating (TPLF).

3/21/2023 - 25 min read

Waiting for CMS’s Section 111 penalties “final rule” – status, updates, and what’s next

Presently, the industry is waiting for CMS to release its Section 111 CMPs “final rule” to the public.

3/17/2023 - 1 min read

Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence

3/8/2023 - 8 min read

New York expands Medical and Indemnity Data call reporting – expansion applies to all member carrier groups regardless of premium market share

2/22/2023 - 19 min read

CMS pushes back the timeline to release its Section 111 penalties “final rule” for one-year (until February 18, 2024)

In a major Section 111 development, (CMS) has extended the timeline to release its Section 111 civil money penalties (CMP) “final rule” until February 18, 2024.

2/13/2023 - 28 min read

TPLF disclosure proposals are introduced in Kansas, Mississippi, and Montana state legislatures

Third-party litigation funding (TPLF) issues will continue to present challenges on several fronts in the new year.

2/7/2023 - 8 min read

CMS makes updates to Section 111 NGHP User Guide (Version 7.0) – updates relate to upcoming changes to the NGHP Unsolicited Response File

As reported in our recent article, in early January CMS released a new version of their Section 111 NGHP Section 111 User Guide (Version 7.0, January 9, 2023).

1/17/2023 - 6 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 5.6) – Updates to Open Debt Report, Compromise Requests, and Go Paperless notifications

The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 5.6 (January 9, 2023).