blackburn group inc.

MMSEA Section 111 Mandatory Data Reporting

MMSEA Section 111 Mandatory Data Reporting

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 added Mandatory Reporting requirements with respect to Medicare beneficiaries. All liability insurance (including self-insurance), no-fault insurance and workers' compensation insurance must report or face potential penalties for non-compliance. A penalty of $1,000 per claim per day will be assessed against any applicable plan for cases of non-compliance. We provide a fully comprehensive and integrated solution for all your Mandatory Reporting and Settlement Solution Needs. The options include:

  • Exporting – All CMS-required fields using our specially designed "easy fill" XML file format for direct data import
  • Customization – Add on database that can be synchronized with your claims system
  • Manual Entry – All required reporting fields are entered manually through the application portal

Benefits of Service Include:

Our proprietary application is an encrypted, secure, and reliable tool that is a low cost solution for your reporting needs. It provides User-friendly, Single Screen Viewing and Entry Capabilities via a fully integrated web-based application that identifies all claims and their risk levels. The application is designed to meet the regulatory reporting needs of all small, medium, and large sized Insurance Carriers, Self-insured Employers, and Third Party Administrators (TPAs) who handle workers' compensation and liability claims. You can check the status of your claims 24 hours a day, 7 days a week.

  • Excellence in customer service with a dedicated point of contact
  • Guaranteed on-time, fully Automated Quarterly Reporting to CMS during your assigned reporting period
  • Internal Validations completely prepare your claim submission to eliminate any CMS rejections

Advanced Data Analytics

Blackburn Group, Inc.'s MSA RiskPro® Mandatory Reporting System contains the most advanced business rules and technology that are consistent with MMSEA Section 111 regulations. Each claim is validated on entry, either when there is an update by the user or through CMS. In addition, Flags and alerts clearly showing missing fields. All claims are automatically checked for errors by internal validation for response files. In addition, the system utilizes threshold rules to prevent over reporting of claims, thus allowing the user to focus only on those claims that are required to be reported.

Medicare Regulations

MMSEA Section 111 Data Reporting is occurring now. The Centers for Medicare and Medicaid Services will be enforcing allocation reports and compliance for all casualty programs. Are you compliant with the regulations? Recent legislation (Public Law No. 110-173), has expanded the definition of the administrative requirements designed to protect the Medicare system from medical expenses considered the primary obligation of private sector plans, including insured and self-insured workers' compensation, liability and no fault plans.

The Social Security Act requires that parties to a settlement protect Medicare's interests as a secondary payor to other available insurance plans. Protecting Medicare's interests has meant reimbursing monies paid by Medicare as "conditional payments" and establishing an allocation for the payment of future Medicare eligible medical expenses.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA-111) creates reporting requirements that will enable Medicare to examine settlements, judgments and awards to ensure that conditional payments are identified and reimbursed. If the settlement does not contain an allocation, Medicare has a statutory right to recover up to the entire amount of the settlement, judgment or award. The Act does not change current practices regarding Medicare Set-Aside agreements (MSAs), however it emphasizes positive enforcement of protection and recovery measures for Medicare with respect to all classes of casualty claims. Keep informed by visiting the CMS website for updates.

Newly Enforced Requirements

The Responsible Reporting Entities (RRE's) or its designated agent must make a specific determination for each claimant under a workers' compensation, liability or PIP (personal injury protection)/no-fault program regarding whether the party is a Medicare beneficiary. For Medicare beneficiaries, information regarding the claimant and claim must be reported to the Centers for Medicare and Medicaid Services (CMS) so that a determination can be made regarding coordination of benefits and applicable recoveries. A penalty of $1,000 per claim per day will be assessed against any applicable plan for cases of non-compliance. Choose our independent, experienced team of professionals that are committed to work for you. We have over 30 years of experience in administering the entire claim adjudication process, including Medicare Set Asides (MSA's). Our MSA Best Practices have been recognized throughout the industry as a leading source of quality management. We understand and appreciate the importance of your time, and are available to compliment your existing resources in reducing your costs on each and every claim file.

Blackburn Group Inc.'s MSA RiskPro® Mandatory Reporting Solution is your one stop shop for complying with the Federally Mandatory Section 111 reporting rules.

Call us at 1 (585) 586-4530 for a free demo today!

Structured Settlements

Structured Settlements

A structured settlement is a helpful financial tool created by professionals to assist injured people. The benefit of using a structured settlement versus accepting a lump sum payment is that regular payments are made over a specified period of time to match your future needs and goals. This ensures that your needs will always be met.

Structured settlements apply to a wide variety of personal injury cases regardless of how much money has been accepted for the settlement.

Structured settlements were created because legislators were concerned that injured people who take a lump sum settlement often spend it all before meeting future obligations, including their medical care.

Financial advantages include guaranteed payments from the annuities purchased to fund your structured settlement account, a lifetime exclusion from income, dividend and capital gains taxes, and the ability to maintain eligibility for federal and private health care plans.

Call us today to discuss your most complex claim settlement needs. We would be very pleased to assist you!

Lien Verification and Negotiation

We have independent, proprietary "Best Practice" data and professional services to help manage your lien verification and negotiations!

Our experienced team of legal professionals provides inexpensive, quick, and efficient services for you and your client to determine the exact lien amount and obtain all of the details for claim settlement positioning. Our analysts minimize, and in some cases eliminate lien reimbursement. We know how insurance plans operate, and we will leverage our legal team experience to benefit you. You will have a dedicated single point of contact for all of your cases so that whenever there is a question with your case, you will know who is coordinating it. We can help resolve:

  • Medicare lien negotiations
  • Medicaid lien negotiations
  • Health insurance lien negotiations
  • Employee Retirement Income Security Act (ERISA) lien negotiations
  • Workers Compensation insurance lien negotiations
  • Liability insurance lien negotiations
  • Claim settlement lien negotiations
  • Disability insurance lien negotiations
  • Claim negotiation lien negotiations
  • Medical cost projection lien negotiations
  • Conditional payment lien negotiations
  • Fully-funded Health Plans lien negotiations
  • Private-funded Health Plans lien negotiations
  • Self-funded Government Plans lien negotiations
  • and Stop Loss insurance programs lien negotiations.

We are completely independent and can offer unbiased advice dedicated specifically for your needs!

We resolve liens with all health plans including Medicare, Medicaid, Private-Funded Health Plans, Fully-Funded Health Plans, Stop Loss programs, Employee Retirement Income Security Act (ERISA), and Self-Funded Government Plans. To get started, all you need to do is complete the appropriate Referral Form and email it to us. Or, just call us and we would be pleased to assist you. Call us today to begin reducing your Liens! Click here for our results!!

Claim Benchmarking

Claim Benchmarking

Our Risk Compliance associates are recognized and qualified to assist with your most complex Property and Casualty insurance business needs!

Our unique and proprietary RiskPro® technology allows us to help you solve your most complex risk and claim issues. Whether it is an individual claim or an entire program, our analysts are prepared to assist you.

We are recognized as a leading resource by A.M. Best Company as a Recommended Expert Service Provider in the Insurance and Financial industries, and by the Risk and Insurance Management Society Buyers Guide for Enterprise Risk Management and Claim Settlement Solutions based upon readership choice for quality services.

Our solutions include compliance for all operational risk areas including Best Practice Risk Audits, Client Support Audits, Due Diligence Audits, Insurance and Reinsurance Audits, Premium Audits, Reserve Audits, Sarbanes Oxley (SOX), International Organization for Standardization (ISO), and All Purpose Audits. We customize all products and services to our clients' needs, and save clients up to 40% of their current enterprise risk and claim settlement costs by utilizing our unique products and services. Call us today!

Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.