MEDICARE SECONDARY PAYOR RULES:

This information is provided  by your Arkansas Medicare contractor.
In an effort to better serve our customers and their counsel, in setting up worker’s compensation, liability, or no-fault cases with Medicare. If the following guidelines are followed, the Medicare Secondary Payor (“MSP”) process will work much more smoothly and efficiently.  A smoother and more efficient process will, in turn, benefit you, your client/our beneficiary and the Medicare program as a whole. 

The first step which you must follow any time Medicare is a payor in a third party claim is to gather all relevant information regarding the beneficiary, the claims and the payments made.  This information should be incorporated into a notification which must be made to Medicare (see below), preferably at the onset of your case.

The following is a list of all necessary information which should be gathered prior to notifying Medicare and incorporated into a notification to MSP:

• the full name and address of the Medicare beneficiary (include middle names and initials as beneficiaries often have the same or similar first and last names)
• the Health Insurance Claim or HIC Number of the Medicare beneficiary (not always the same as their Social Security Number)
• the full name, address and telephone number of plaintiff's counsel
• the full name, address and telephone number of defendant's counsel
• the full name, address and telephone number of any involved insurance company (specifics regarding their representative/agent  and claim/policy number(s) should be included if known)
• the date of the incident and a detailed listing of all claimed injuries and/or all medical problems 
• a completed HIPAA-compliance authorization form  signed by the Medicare beneficiary

Beginning on January 8, 2001, CMS has required that all notifications to MSP must be submitted to the Coordination of Benefits (“COB”) Contractor.  (Please note that we do NOT serve as the Coordination of Benefits Contractor and will not be able to assist with the case until the information is released to us from the COB Contractor.  Once the notification is prepared, it must be sent to:

MEDICARE – COORDINATION OF BENEFITS CONTRACTOR
MSP Claims Investigation Project
P.O. Box 5041
New York, New York 10274-0125
Telephone: (800) 999-1118
Fax: (646) 458-6767

Our recommendation is that you notify the COB Contractor by telephone.  If the COB Contractor requires clarification, or additional information, they will be able to request it during your call and you will be able to conclude that call knowing that your case file has been established.  Please document the name of the individual you speak with for your records.

If your client receives assistance from the state Medicaid program, you must contact their subrogation department to determine Medicaid’s recovery interest.  For Arkansas residents, the contact information is:

ARKANSAS DEPARTMENT OF HUMAN SERVICES
Tort/Subrogation Office
P. O. Box 1437 Slot S296
Little Rock, AR 72203
Telephone:  (501) 682-8324
Fax:   (501) 682-1644.
   

Note that the Arkansas Department of Human Services administers the Medicaid program and is the only agency authorized to address Medicaid recovery issues.

For the purposes of Medicare’s interests, once the COB Contractor receives your notification, the Contractor will then conduct the initial research and assign the proper jurisdiction for your case.  Once your case is assigned a jurisdiction by the COB, your actual case work will most likely be handled in by us here in Arkansas (assuming, of course, that it is an Arkansas case). 

Our contact information is:

Arkansas Blue Cross and Blue Shield -- Medicare Services
Medicare Secondary Payor
P.O., Box 1418, Little Rock, AR 72203-1418
Telephone: (501) 210-9120 (Effective November 1, 2004, the service line will be manned from 9:00 A.M. until 4:00 P.M. Monday through Friday)
Fax: (501) 210-9150

Once your case is assigned to Arkansas, please provide all of your contact information to us and request that the Arkansas MSP office respond to your office.   If you have settled your case by this time, please also provide the date and amount of all recoveries along with itemizations of your attorneys’ fee and costs.

Because Medicare contractors specialize in the administration of various benefits under the Medicare program, i.e., Part A, Part B, Durable Medical Equipment, Home Health, etc., your client (our beneficiary) may well have multiple claims, all related to a single illness or incident, which have been processed by multiple Medicare contractors.  For this reason, notification to Medicare is critical if you are to avoid delay.

Beginning October 1, 2004, all Medicare contractors will be able to access all claim payment information via a single database.  However for claims involving dates of service prior to 1999, the extraction process for is very complex and the contractor will require a minimum of 4 months time in order to complete the process.    For this reason, it is critical you notify the Medicare program as soon as possible. 

Notify Medicare first at the time you take the case; don’t wait until you settle or resolve your case to notify the Medicare program.  Any delay in Medicare’s notification may certainly have the potential to result in a delay in providing the necessary information to you and may impact your ability to settle your case.  Notify us first and minimize the possibility of any delay!

For more information click here.