Understanding the Exposure SCHIP Mandatory Insurer Reporting & MSP Compliance

1. Understanding the Exposure SCHIP Mandatory Insurer Reporting & MSP Compliance

2. Mandatory Insurer Reporting (MIR) • Required on all NGHP (Liability, No-Fault, Self, WC) • Requires that primary payers check Medicare beneficiary status on ALL claims quarterly • Requires reporting of ALL claims involving Medicare beneficiaries quarterly • Requires reporting S/J/As on ALL claims involving Medicare beneficiaries • “Contested” cases exception • Applicable regardless of whether or not future medicals are closed

3. NGHP MIR Timeline RRE Registration between 5/1/09 and 9/30/09 Only 1 reporting agent, TPA is not the RRE At time of registration, reporting date established Testing of MQF from 7/1/09 to 12/31/09 Ensures Medicare verification process works properly Requires seven (7) fields of data Testing of Production Files from 1/1/10 to 3/31/10 Ensures 180+ field feed properly Requires massive claims system additions 1st live report between 4/1/09 and 6/30/10 $1000/day/claim penalty begins Retroactive reporting required from 7/1/09

4. RRE Registration Section 8 (pgs 22-26) NGHP User Guide • Step 1: • Identify the Authorized Representative • May not be an agent • Must be able to contract on behalf of the RRE • Identify the Account Manager • May be an agent of the RRE • Controls the administration of the RRE’s account • Identify COBSW Users • Manages the reporting process

5. RRE Registration • Step 2: Determine Reporting Structure • How many RRE IDs are you planning on obtaining? • Multiple RRE IDs • 1 RRE ID = 1 Reporting Agent = 1 Quarterly Report • Multiple RRE IDs = 1 Reporting Agent = Multiple Quarterly Reports • Step 3: RRE Registration on the COBSW • PIN & RRE ID will be mailed to the Authorized Representative • Step 4: RRE Account Set up on the COBSW • May be done by the Account Manager • Step 5: Authorized Representative Return Signed RRE Profile Report

6. ISAR MIR Workflow • Identify : Check Medicare status on all claims every month • Satisfy: Research/negotiate and resolve conditional payments prior to S/J/A • Allocate : Future medicals in the S/J/A • Report: On all Medicare eligible claims, report the MIR data to CMS

7. The OneSource Solution • Solution for RRE should include: • Meet the full scope of SCHIP requirements • Produce the proper MSP products: • In accordance with Gallagher Bassett protocols • Medicare Set-Aside Allocation (MSA) • Claims Settlement Allocation (CSA) • Conditional Payment Research (CPR) • Conditional Payment Negotiation (CPN) • Your cooperation is required to: • Avoid $1,000/claim per day penalty • Reduce amounts paid for conditional payments • Protect against future liability (MSA/CSA) • Back-fill claims data to ensure MIR compliance

8. Selecting your Reporting Agent • Data Integrity • Cost • Training • Transparency • Data Consolidation • Risk/Rewards

9. Program Structure and use of RRE ID’s • Client RRE using a Reporting Agent • Client RRE using multiple Reporting Agents • Client RRE self-administering

10. Post Registration Responsibilities • Clients using Reporting Agents • Clients Self-Administering and internally handling compliance with MMSEA 111.

11. Common misrepresentations of the Act • Who is the RRE? • What coverage and policy holders fall under Act? • Captives, Insurance Pools, State Guarantee Funds? • Carriers in receivership • Exposure Claims/Occupational Dease

12. Fines/Penalties/Data Integrity • Technology Requirements needed for compliance? • Penalty situations • When will fines be instituted?

13. Contact Information 101 Riverfront Blvd, Suite 100 Bradenton, FL 34205 866-672-3453 x 1340 tom.blackwell@gouldandlamb.com dana.rose@gouldandlalmb.com www.gouldandlamb.com