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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”…

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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.

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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…

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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.

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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…

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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).

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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…

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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…

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June 12, 2020

CMS releases Section 111 alert regarding the reporting of no-fault insurance and med-pay policy limits on claim input files

CMS issued a new Section 111 alert on the reporting of personal injury protection, and Med-Pay policy limits on non-group health plan claim input files in situations…

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June 3, 2020

CMS to enhance its MSPRP to allow authorized users to view and print conditional payment correspondence

Starting July 13, 2020, authorized MSPRP users will be allowed to view and print CMS conditional payment correspondence.

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May 28, 2020

COVID-19 and workers’ comp: Managing rising claim volume and costs

With thousands of essential employees reporting to work—including health care workers—there could be an influx of workers’ comp claims related to the virus.

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May 15, 2020

CMS releases new WCMSA reference guide (Version 3.1)

The Centers for Medicare and Medicaid Services (CMS) has just released its latest version of the WCMSA reference guide version 3.1 (May 11, 2020).

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May 11, 2020

Court dismisses law firm’s attempt to interplead HHS to resolve Medicare’s conditional payment claim

The United States District Court for the Western District of Missouri in Fowler Pickert LLC v. Glasgow, et. al., 2020 WL 1955266 (W.D. Missouri, April 23, 2020) had to…

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May 6, 2020

COVID-19 – State by state legislative and regulatory resources

Many insurers are concerned with how COVID-19 related legislative and regulatory changes could impact exposure and liability going forward.

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May 1, 2020

Court finds state of Rhode Island compliant with Section 111 despite its inability to obtain social security information to determine Medicare status and enforces settlement

The U.S. District Court in Ruiz v. Rhode Island was called upon to address whether a personal injury settlement should be enforced even though the defendant was unable to…