Medical Reporter

NEW MEDICARE SECONDARY PAYER REQUIREMENTS:
ISO helps carriers comply with mandate

On July 1, 2009, new mandatory reporting of payments to Medicare-eligible workers, written into the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), went into effect for workers compensation, liability insurance (including self-insurance), and no-fault insurance.

For our workers comp clients, ISO has enhanced its Workers Compensation Transactional Reporting Program (WCTRP) to include additional fields that satisfy the new reporting requirements. We also updated our V-Comp Solutions Medical Reporter feed to ISO ClaimSearch® Universal Format claims reporting process. Through the ISO ClaimSearch Medicare Secondary Payer Reporting Service, ISO will report claims data to the Centers for Medicare & Medicaid Services (CMS) on behalf of our customers.

ISO has developed the necessary record layouts, registration procedures and processing workflows – including CMS acknowledgment and error rejection/correction routines — that allow carriers reporting through us to fully comply with the mandate.

Timeline for CMS mandates (updated 7/09)

• 9/30/09 — carriers must register their data-reporting method
• 7/1/09 — test and production Query Input Files accepted
• 1/1/10 — Claim Input File testing begins
• 1/1/10 — production Claim Input Files accepted
• 4/1/10 to 6/30/10 — initial production Claim Input File submissions due

NEW MEDICAL DATA CALL:
ISO updates its WCTRP in response to call for additional medical data

To help carriers comply with a new data collection call for more detailed medical data, ISO has updated its WCTRP and made the enhanced transactional reporting plan available to customers on April 1, 2009. The enhanced WCTRP accommodates the call's 28 new data elements, which include 5 policy/claim linking elements and 23 medical procedure and diagnostic elements.

The call comprises medical transactions for all workers compensation claims, including medical only, beginning with transactions occurring in third-quarter 2010. Carriers must report third-quarter 2010 transactions by December 31, 2010, and continue reporting on a quarterly basis thereafter. All submissions of transactions occurring within a quarter are due at the end of the following quarter. Optionally, carriers can report monthly. On behalf of clients using our enhanced WCTRP to collect the additional data elements, ISO will handle the data feed to the data collection organization to satisfy their reporting requirements.

Timeline for new medical data call

• 2Q 2010 — certification testing begins
• 3Q 2010 — first quarter of transactions affected by new call
• 12/31/10 — carriers must report 3Q 2010 transactions

IAIABC'S EDI MEDICAL
ISO continues to support carriers' compliance

The work of the IAIABC's Medical Committee continues, as it develops the common definitions and coding structures for reporting medical billing/payment transactions that meet the technical and business requirements of claims administrators and state jurisdictions and ensures that the IAIABC medical transactions are current with HIPAA-mandated standards. ISO continues to support carriers in complying with reporting requirements for medical billing/payment transactions by keeping current with the latest IAIABC EDI standards and jurisdiction-specific requirements and will transmit carriers' transactions to the appropriate jurisdictions on their behalf.