- Workers CompensationCMS has issued new regulations regarding Medicare Workers Compensation Set Asides, while these do not as yet apply to Liability settlements, they are informative. See Version 3.1 of the WCMSA Reference Guide has been posted to the Downloads section of the Workers’ Compensation Medicare Set Aside Arrangements page on CMS.gov. Refer to Section 1.1 for a summary of updates.
- Premises LiabilityOPL seeks to have the party ultimately responsible pay the claim.It is our mission to correct the excessive dumping of medical claims on health plans when there are other primary responsible payers. Just because a claim is payable under the health plan does not mean it should be paid, or remain paid. There are many situations where other insurers have insured specific risks (i.e. Workers comp, Auto, Property, Premises liability, etc.) who are obligated to pay primary to Health, but as these insurers do not issue insurance cards, or have complicated claims processes, providers bill health plans. It is our mission to identify these claims and recover for our clients.
- Personal InjuryPersonal Injury Protection (PIP) coverage should be included when reporting the No-Fault Insurance Limit (Field 61 of Claim Input File). As such, NGHP RREs must combine both Med Pay and PIP coverage limits for a policy when they are separate coverages being paid out on claims for the same injured party and incident under a single policy.