Settlement

10/12/2020 - 5 min read

Automation requires emotional intelligence to deal with large loss claims handling

Large loss claims can be streamlined by AI and automation, but needs the emotional intelligence brought to claims resolution by the handler and the insurer.

10/6/2020 - 5 min read

CMS releases new NGHP Section 111 User Guide (Version 6.0) and updated accepted/excluded ICD code listings

On 10/5/20, CMS released an updated Section 111 NGHP User Guide, V. 6.0. They also released updated versions of accepted and excluded ICD-9 and ICD-10 codes for 2021.

9/10/2020 - 4 min read

The future of claims: Delivering at the moment of truth

The future of claims is about elevating the customer experience, and insurers that aggressively pursue digital enablement today will be primed to excel tomorrow.

9/3/2020 - 5 min read

From real-time fraud detection to remote claim assessments – how lockdown has changed priorities for insurers and policyholders alike

Digital technology has become critical to provide core claims services during lockdown. Verisk is at the forefront in this field with a full range of claims solutions.

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8/25/2020 - 12 min read

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.

8/12/2020 - 4 min read

Simplify the lender-insurer information exchange

The manual process needs automation, which can benefit both lenders and carriers

8/7/2020 - 17 min read

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” for its failure to reimburse Aetna’s Medicare Advantage Plan recovery claim.

7/8/2020 - 6 min read

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.

7/2/2020 - 21 min read

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 payments made for a beneficiary’s treatment from the amounts of a settlement agreement representing both past and future medical care.

7/1/2020 - 2 min read

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).

7/1/2020 - 1 min read

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 now scheduled for August 2020.

5/11/2020 - 23 min read

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 address whether it had proper jurisdiction to determine how much a Medicare beneficiary owed to Medicare from his settlement proceeds in reimbursement of Medicare’s conditional payments

5/1/2020 - 19 min read

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 obtain the plaintiff’s social security number, or the last five digits of his SSN, to determine his Medicare status through CMS’s Section 111 Query Process.

4/28/2020 - 2 min read

New tools translate to higher lender/insurer efficiency

Verisk is rolling out CV-VaaS (Verification as a Service) to connect key information between lenders and insurers via a new contributory database.

4/22/2020 - 5 min read

To build or not to build: Getting portal claims solutions right in the wake of whiplash reform

Crucial questions remain over whether insurers have the in-house capacity and expertise to develop truly fit-for-purpose solutions, or if they should opt for an industry partner to deploy an off-the shelf solution.