CMS Town Hall Meeting Addresses PAID Act

On Wednesday, June 23, 2021, the Centers for Medicare and Medicaid Services (CMS), hosted a town hall presentation regarding the PAID Act and its implications to the Section 111 Process.  The transcript of today’s call will be available on the CMS.gov website in roughly 2 weeks.

While there were no significant updates or changes based on our prior communications on the subject found here, below is a summary of the high points:

  • Implementation Schedule
    • Testing Webinar: September 9, 2021
    • Testing Period: September 13, 2021 to December 10, 2021
    • Go Live: December 11, 2021
  • CMS does not require testing, but it is strongly encouraged.
  • Test data will be provided so that authentic Query Response files can be received during testing.
  • After the go live date of December 11, 2021, you must use an updated HIPAA Eligibility Wrapper (HEW) tool. There is no facility to continue receiving the former Query Response file layout.
    • Updated HEW software for both Windows and Mainframe systems will be available September 13, 2021.
  • The Coordination of Benefits Secure Website (COBSW) will provide Medicare Advantage (MAP) and Part D Plan data beginning October 4, 2021. Note that the 500 query limit will still apply.
  • The Query Response File will contain the past 3 years of MAP information, up to 12 separate occurrences. If a Responsible Reporting Entity (RRE) believes an Injured Party has more than 12 separate MAP occurrences in the most recent 3 years, then feel free to contact the COB Center EDI Representative for more information.
  • The inclusion of the MAP / Part D plan data does not change the current guidance and requirements surrounding Section 111 reporting.
  • CMS is not anticipating any changes to the Query process timeframes; query response files should still be returned within 14 days.

How does this affect you, as a client of ECS?

As your Section 111 Submission Agent, ECS exchanges all files with CMS on your behalf.  ECS will conduct extensive testing with CMS, and that testing will apply to all clients and RREs.  The additional MAP / Part D plan data will be captured in ECS’ system and made available to the ECS MSP Operations Team as well as to those clients that wish to receive it.  Additional details regarding the provision of the MAP / Part D data are forthcoming, as our Section 111 Team continues to digest and dissect the Query Response file changes.

ECS will continue to closely monitor any Section 111 reporting changes and outline the critical context of those reporting changes to you.  Contact us today to learn more about how these changes may impact your claims process, or to learn more about our tailored Section 111 reporting solutions. Our Mandatory Insurer Reporting Team can be reached at MIRService.Support@examworkscompliance.com or 678-222-5454 to schedule an evaluation about your program today.

Scott Huber

Scott Huber

Scott Huber is the Senior Vice President of Technology at ExamWorks Compliance Solutions. Scott oversees all internal and external technology services for ECS, including the award-winning MIR Service Section 111 Reporting platform. A native Floridian, Scott is a graduate of the University of Florida and works out of ECS headquarters in Lawrenceville, Georgia. Scott can be reached at 678-256-5135 or scott.huber@ExamWorksCompliance.com