II.
Extension of Current Dollar Thresholds for Liability Insurance(Including Self-Insurance) and Workers’ Compensation
The interim dollar reporting thresholds set forth in Section 11.4 of version 3.1 of the MMSEA 111 Liability Insurance (Including Self-Insurance), No-Fault, and Workers’ Compensation User Guide have all been extended by one calendar year.
Under Section 11.4, “Workers’ Compensation ORM”, the date 12/31/2011 is changed to 12/31/2012.
Under Section 11.4, “Liability Insurance and Workers’ Compensation TPOC Amounts”, the last four bullets are revised to read:
• Claim reports where the last (most recent) TPOC Date is prior to January 1, 2013 with TPOC Amounts totaling $0.00 - $5,000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2013 with a total TPOC amount less than or equal to $5000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2013 through December 31, 2013 with TPOC Amounts totaling $0.00 - $2000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2014 with a total TPOC amount less than or equal to $2000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2014 through December 31, 2014, with TPOC Amounts totaling $0.00 - $600.00 are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2015 with a total TPOC amount less than or equal to $600.00 will be rejected.
• No threshold applies to claims where the last (most recent) TPOC Date is January 1, 2015 and subsequent.
November 09, 2010
Medicare Secondary Payer Mandatory Reporting Provisions in
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(See 42 U.S.C. 1395y(b)(7)&(b)(8))
