Medicare Secondary Payer Reporting Requirements
Mandatory Medicare Secondary Payer (MSP) Reporting
Beginning this year, Empire, as well as all group health plan insurers or third party administrators, is required to provide reports to CMS1 about plan participants on behalf of group health plans. The collected data enables CMS to identify Medicare beneficiaries who are covered by group health plans and accurately pay claims by determining primary versus secondary payer responsibilities.
CMS defines employer size under this mandate as having 20 or more full- or part-time employees for each of 20 or more calendar weeks in the current or preceding calendar year. That is, total employees and not just those eligible for, or covered under, your group health plan(s).
Required Member Data
The following member data is required for all actively employed enrolled subscribers to your Empire health plan(s) and newly covered spouses and/or domestic partners of Empire plan subscribers beginning January 1, 2009. The SSNs of covered spouses and domestic partners with effective dates prior to January 1, 2009 will be requested at a later time as they must not be reported until January 1, 2011.
| Contract Number|
| Member Name|
| Social Security Number (SSNs)|
| Date of Birth|
| Group Number |
| Sub Group Number (if applicable)|
In addition, the required group data includes,
| Group Name and Address|
| Group Number and Sub-Groups if applicable|
| Group Tax Identification Number (TINs/EINs)|
| *Total Number of Employees |
Exclusions Retirees are excluded from the mandate. Information on members covered as Medicare disabled will not be collected as a part of this initiative as it is being reported and captured under our existing enrollment processes. In addition, child dependent information will not be collected. Empire will not collect dependent child information at this time since the Medicare scenario is atypical and the risk of non-collection is minimal
The information can be submitted to us in any of the following ways:
| Secure email – There is a spreadsheet that can downloaded, completed and sent via Secure eMail to CMSReportingLocal@wellpoint.com. Registration for first-time users of our secure email system is here. If you need technical assistance on Secure eMail, contact our eBusiness Help Desk at (866) 755-2680. |
| Tape/electronic submission (for those groups that are already providing eligibility data to us in this medium)|
| Paper submission mailed to us. You can download the Eligibility Form, print and complete it and mail it to: Empire, 11 Corporate Woods Blvd., Albany NY 12211, Attention: MSP at Maildrop 4L. Due to the sensitivity of the data, we encourage you to take the necessary precautions to secure and protect your information. We suggest that you utilize a mail vendor with tracking mechanisms in place when sending your data.|
We encourage you to use Secure eMail or Employer Online Services to supply the data to assure its security.
You can view or download an FAQ
and get more information at the CMS site
You should review the federal requirements in consultation with your own legal counsel to determine whether any other requirements apply or any other actions are needed on their part.