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Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), sometimes referred to as “Section 111”, added mandatory reporting requirements for liability insurers, no-fault insurers, and workers’ compensation insurers, collectively referred to as Non-Group Health Plan (NGHP) insurers. An NGHP is obligated to notify Medicare about any settlements, judgments, awards, or other payment received by or on behalf of a Medicare beneficiary. The reporting requirements for NGHP insurers under MMSEA Section 111 first became effective on May 1, 2009.

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In response to the requirements mandated by the Centers for Medicare and Medicaid Services (CMS), Blair & Company has designed and implemented robust proprietary software that not only integrates with CMS directly, but also with any intermediary vendor designated by our clients. Our fully featured systems coordinate all required data collection, data input, error-checking, data submission and response handling as required by CMS. Compliance with these complicated issues requires a multi-faceted approach that is accomplished with a combination of knowledgeable staff and a sophisticated claims system. Our staff has intimate understanding of Conditional Payments, Medicare Set-asides, and Mandatory Insurer Reporting. This enables our claims examiners to identify any potential Medicare obstacles early in the claims process and seek resolution of the claim expeditiously. Blair & Company examiners and supervisors have been trained on CMS reporting requirements and the procedures required:

• To determine a claimant’s Medicare eligibility;
• To reimburse Medicare for Conditional Payments; and
• To report to CMS all bodily injury settlements and Medical Payments when a claimant is Medicare qualified.

Blair & Company examiners and supervisors are required:

• To ensure that counsel appointed by our clients are made aware of the Medicare requirements;
• To ensure that any change in Medicare qualification status of a claimant/plaintiff is immediately advised to appointed counsel; and
• To ensure that all settlement documents drafted by appointed counsel relating to a Medicare qualified claimant are sent to our clients for approval.

Blair & Company has positioned itself as a clear choice in addressing the many considerations and complexities of CMS compliance. Our dynamic software, combined with our knowledgeable and experienced staff, result in a comprehensive MMSEA Section 111 compliance solution.

Blair & Company is compliant with all relevant legislation and regulations including:

• Adjuster Licensing
• Anti-Bribery
• Anti-Money Laundering
• Complaints Handling
• Data Protection
• Disaster Recovery
• Document Retention
• External Conflicts of Interest
• Fair and Equitable Treatment of All Individuals
• Internal Conflicts of Interest
• Lloyd’s Claims Management Principles and Minimum Standards
• OFAC Compliance
• Privacy Requirements