MSP Coverage Identification
In order to meet CMS requirements to coordinate Medicare beneficiary benefits correctly, HMS is able to identify and verify Medicare Secondary Payor coverage available to members enrolled in Medicare Advantage and Part D plans. HMS's services are designed to augment and validate the information currently maintained by the CMS Coordination of Benefits Contractor (COBC). Instead of relying on annual employer questionnaires like the COBC, however, HMS's approach relies on other data sources that we maintain or have access to in order to proactively identify Medicare members who might have other Group Health Plan coverage through their employer or their spouse's employer. We then contact both the primary carrier/PBM and the employer to validate the coverage information before passing it on to our Medicare Plan clients so that they can coordinate benefits properly and determine primacy.
MSP Payment Protection
Associated with the recently enacted MSP Reporting Requirements, HMS can help Medicare Advantage Organizations to offset the premium adjustments associated with their enrollees who are erroneously reported as having MSP coverage.
Effective January 2010, the MSP adjustment will no longer be based on an estimate of a Medicare Advantage Organization’s enrollees with MSP coverage. The adjustment will be based on the MAO’s actual number of beneficiaries that have open MSP Occurrences on Medicare records.
CMS sends a monthly file to each Plan identifying the MSP status of all of its enrollees who have open MSP Occurrences. This file includes some data elements the Plan needs to submit an ECRS Assistance Request.
HMS can help our Plan clients affirm the accuracy of this monthly MSP file. We will verify the coverage status of each member on the file and confirm whether or not the MSP information provided is accurate. Where it is not, the Plan can send an ECRS Assistance Request to the COBC for consideration.
We give you TPL information just in time, when you need it: At enrollment, at re-determination, at point of service, and in claims review.
