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ISO Claims Partners

February 18, 2020

CMS’s Section 111 penalty proposals are here

CMS has released its long-awaited Section 111 civil money penalty proposals for non-group health plans, as well as group health plans.

February 12, 2020

CMS releases new NGHP Section 111 User Guide (Version 5.8)

CMS has released an updated Section 111 User Guide (Version 5.8, January 31, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).

February 12, 2020

California spotlight: Medicare Advantage recovery rights

The issue of Medicare Advantage Plans recovery rights has catapulted to the compliance forefront over the past few years following a series of court rulings finding that…

January 21, 2020

CMS holds town hall call to discuss NGHP conditional payment recovery issues

On 1/14/20, CMS held a call to discuss recovery issues related to the Commercial Repayment Center and on-going responsibility for medicals with respect to non-group…

January 10, 2020

Philadelphia law firm reaches settlement with U.S. Department of Justice regarding alleged failure to resolve Medicare conditional payments

The United States Department of Justice (DOJ), United States Attorney’s Office for the Eastern District of Pennsylvania has issued a news release reporting that a…

December 17, 2019

Ohio court rules that Medicare Advantage Plans can sue insurers for “double damages” under the MSP

The U.S. District Court in Ohio ruled MAPs can sue insurers for “double damages” under the MSP and the three-year claims filing period doesn’t create a statutory…

December 9, 2019

CMS to host town hall meeting to discuss CRC ORM recovery issues related to NGHP claims

CMS announced it will host a town hall meeting on recovery issues related to the CRC and on-going responsibility for medicals for non-group health claims.

December 5, 2019

Illinois court dismisses Medicare Advantage Plan suit for “double damages” on standing grounds

In MAO-MSO Recovery II, LLC v. State Farm, 2019 WL 6311987 (C.D. Ill. Nov. 25, 2019), the United States District Court for the Central District of Illinois found that an…

December 2, 2019

CMS retains its $750 “Low Dollar” threshold for 2020

CMS announced it is retaining its current $750 low dollar threshold in 2020.

November 22, 2019

CMS’s expected release of its “future medicals” (LMSA) proposals delayed until February 2020

OIRA announced CMS’s expected release of its Notice of Proposed Rulemaking (NPRM) proposals for “future medicals” has been pushed back to February 2020.

November 21, 2019

Release of CMS’s Section 111 penalty proposals delayed again – pushed back to December

OIRA announced CMS’s expected release of its Notice of Proposed Rulemaking proposals for Section 111 civil money penalties has been pushed to December 2019.

November 20, 2019

CMS’s new Section 111 alert addresses MBI reporting

CMS has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.

November 15, 2019

Litigation insights offer the key to rising claim costs

Legal analytics make it possible for insurers to derive actionable insights from legal data to improve claims handling and litigation outcomes.

November 15, 2019

Successful workers’ comp analytics starts with the right plan

Workers’ comp analytics can improve claims process by identifying high-severity claims early, promoting consistency in claim handling, and improving return-to-work…

November 15, 2019

All-or-nothing automation? Incremental change is a winning proposition

Robotic process automation (RPA), machine learning, and AI can be embedded in processes throughout the claim life cycle—from triaging through settlement.