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ISO Claims Partners

September 28, 2020

CMS discusses conditional payment issues on NGPH applicable plans webinar

On 9/24, CMS and the CRC held a webinar on redetermination requests as part of the administrative appeals process for conditional payment disputes of non-group health…

September 10, 2020

11th Circuit rules Medicare Advantage downstream entities can sue for double damages under MSP’s PCA provision

The 11th Circuit has ruled “downstream entities”, which Medicare Advantage Plans contract with to help provide benefits, can sue primary plans for “double damages.”

August 25, 2020

U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim

The DOJ’s Attorney’s Office for the Middle District of Pennsylvania has settled a Medicare conditional payment claim with the plaintiff law firm.

August 20, 2020

What’s up in D.C.? Medicare Secondary Payer reform efforts – status update

With the current Congressional session ending on 1/3/21, attention is on two pending Medicare Secondary Payer reform efforts: The PAID Act & the COMP Act.

August 17, 2020

CMS to host CRC NGHP Applicable Plans webinar on September 24th

CMS released a notice announcing they’ll be holding a webinar on the CRC NGHP Applicable Plans Appeals Webinar on September 24, 2020, at 1:00 p.m. ET.

August 14, 2020

CMS holds Section 111 NGHP update webinar

On 8/13, CMS held a webinar on Section 111 non-group health plan reporting. The webinar covered NGHP Section 111 reporting best practices and MSPRP enhancements.

August 11, 2020

OIRA releases updated information Section 111 CMPs

OIRA released an updated notice on the status of CMS’s Section 111 civil money penalties proposals. CMS released the proposals in February 2020 and opened a public…

August 7, 2020

Connecticut court rules Medicare Advantage Plan entitled to double damages

The U.S. District Court for Connecticut in Aetna v. Guerrera, 2020 ruled, in part, the alleged self-insured supermarket was a primary plan and liable for “double damages”…

July 15, 2020

CMS to hold Section 111 NGHP webinar on August 13th

CMS has released a notice announcing it will be holding a webinar for Section 111 non-group health plan reporting on August 13, 2020, at 1:00 p.m. EDT.

July 14, 2020

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) user guide (Version 4.9)

CMS has released an updated Medicare Secondary Payer Recovery Portal User Guide (Version 4.9, July 13, 2020). CMS has made multiple updates to the MSPRP, which the agency…

July 8, 2020

Seven steps to closed: Maximizing claims settlement projects

There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.

July 2, 2020

Eleventh Circuit rules that Florida Medicaid may seek recovery of its past payments from those portions of the settlement agreement representing past and future medical care

In a new Florida Medicaid decision, the U.S. Circuit Court of Appeals for the Eleventh Circuit, in Gallardo v. Dudek, 2020 ruled Florida Medicaid may seek recovery of…

July 1, 2020

CMS releases new NGHP Section 111 User Guide (Version 5.9)

CMS has released an updated Section 111 NGHP User Guide (Version 5.9, June 29, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).

July 1, 2020

CMS’s expected release of its “future medicals” proposals now scheduled for August 2020

An updated notice from the Office of Information and Regulatory Affairs indicates CMS’s long-anticipated release of its “future medicals” notice of proposed rulemaking is…

June 16, 2020

Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact

While individuals will still be able to elect unlimited PIP coverage, for applicable policies issued or renewed after 7/1/20, PIP plans with different coverage limits may…