Mandatory Insurer Reporting Requirements for Medicare

Federal law requires group health plans and liability insurance to report certain information to the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program. The agency is developing regulations concerning the data and submission method for information provided by group health plans. The agency is also developing regulations concerning reporting requirements for liability insurance entities but will not delete existing regulations.

Group Health Plans

• Group health plans or entities that serve as a third party administrator for a group health plan must submit information that is determined by CMS to the agency. CMS requires group health plans to register and obtain an identification code. The procedure requires group health plan subsidiaries to obtain a separate identification number. CMS requires group health plans to register by June 30, 2010, but reporting is not required until after October 1, 2010.

Third Party Administrators

• Third party administrators may enter information under the group health plan's code and the procedures do not require third party administrators to obtain a separate identification code.

Liability Insurance

• CMS requires liability insurance, no-fault insurance and worker's compensation insurance companies to report certain information to the agency. The policy requires entities to report the name of the Medicare beneficiary whose illness, injury or accident was in dispute so that an appropriate Medicare determination can be made.