Medicare Claims Submission for MMSEA111 Reporting

Has missing Medicare beneficiary data become a nightmare for you? In light of the Coordination of Benefits Contractor (COBC) mandated reporting requirements, has the “missing data” problem just become a lot worse?

Transperien has a solution

The Government implemented MSP (Medicare Secondary Payer ) program shifts costs from Medicare to private sources of payment.

COBC’s function

The COBC is responsible for the performance of activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. Its duties focus on activities to ensure that Medicare makes proper payments by identifying the correct payer before payments are made. It is primarily an information-gathering entity.

The COBC does not process any claims, nor does it handle any mistaken payment recoveries or claim-specific inquiries. The COBC has responsibility for establishing individual beneficiary MSP records on the Common Working File (CWF), the official source of beneficiary information for Medicare.

The Government implemented MSP(Medicare Secondary Payer ) program shifts costs from Medicare to private sources of payment

•Before 2009, *Medicare was the “primary payer” — that is, it pays health claims first, and if a beneficiary has other insurance, that insurance may fill in all or some of Medicare’s gaps.

•Since mid-2009, **Medicare becomes the secondary payer. The Primary Payer responsibility now falls on:

1)a group health plan based on either their own or a spouse’s current employment;

2)auto and other liability insurance;

3)no-fault liability insurance; and

4)workers’ compensation situations, including the Black Lung program.

*Medicare is the nation’s health insurance program for qualifying individuals who are 65 and older, disabled, and those with End Stage Renal Disease (ESRD).

** Special circumstantial rules decide on Medicare becoming the secondary payer.

In order to follow the mandatory process are you burdened with the following?



Manually creating query files

Joining data files

Creating headers and formatting

Manually checking the corrected files from COBC

Manually entering data into your claims systems

Lack of validation and no error code checking

Transperien Solution Features

Standard Features:

Add-on database that can be easily modified as new data requirements are added

Automatic query file generation

Add-on database is kept synchronized with COBC for both query and response files

Eliminates error by internal validation for response files

Forms that allow easy data entry with flags and alerts clearly showing missing fields

Error tracking on response files

Premium Features :

Reporting and Analytics

Automated submission to COBC

Add-on database is kept synchronized with your claims system for response files

Price

Our current Special promotional offer includes a complete installation, data integration and 1 year support. For details call us at 1-800-445-2973 or email us at info@transperien.com.

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