Settlement
Social Security Administration suspends processing of third-party requests to determine SSDI status
As of 3/17/20, all the Social Security Administration field offices have been closed to the public in response to the growing COVID-19 pandemic according to its website.…
The Eleventh Circuit rules that the MSP’s three-year “claims-filing” statute is not a prerequisite for filing a private cause of action recovery claim
In reversing a lower court decision, the U.S. Circuit Court of Appeals (Eleventh Circuit) in MSPA Claims 1, LLC v. Kingsway Amigo Insurance ruled compliance with the…
Five data-driven strategies for fighting insurance claims fraud
As we enter 2020, the insurance industry looks much different than it did ten years ago.
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).
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…
How to optimise insurance claims and improve your customer’s experience
Customer expectations are continually evolving, no more so than in the world of insurance. Customers are increasingly digital-first and choosing services based on…
Getting ahead of the claims game: Reducing the cost of personal injury claims, with or without delay to reforms
The 2018 Civil Liability Act is expected to take effect in April this year and is set to transform the handling of low-value personal injury claims in England and Wales.…
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…
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.
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.
CMS retains its $750 “Low Dollar” threshold for 2020
CMS announced it is retaining its current $750 low dollar threshold in 2020.
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.
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.
CMS holds webinar on WCMSA Electronic Attestations for Professional Administration
On 11/6/19, CMS held a webinar on Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancement for Professional Administrators.
CMS releases new WCMSA Reference Guide (Version 3.0)
CMS has released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.0, October 10, 2019).