Claims Administration

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C-416 Claims Reporting  

Reminder concerning Section 715 claim status:

Pursuant to Section 715 (a) of Act 13, which requires receipt by Mcare of a written request for Section 715 coverage within 180 days of the date on which notice of the claim was first given to a health care provider or its insurer, Mcare is providing this reminder due to the passing of the first 180 days in calendar year 2010.

We remind insurers that Section 715(d) of Act 13 states that notwithstanding subsections (a), (b) and (c), all medical professional liability insurance policies issued on or after January 1, 2006, shall provide indemnity and defense for claims asserted against a health care provider for a breach of contract or tort which occurs four or more years after the breach of contract or tort occurred and after December 31, 2005.

For purposes of this subsection, Mcare accepts Section 715 claim status if the dates of criticized treatment are both before and after December 31, 2005, and the last date of criticized treatment is more than four years before notice of the claim was given to the health care provider or their insurer. Accepted Section 715 claims have a coverage limit of $1,000,000 and may have other restrictions OR when certain requirements are met. The acceptance of a claim is subject to all other applicable provisions of the Act and its regulations. 

Reporting of Exhaustion of Primary Aggregate Limits

Medicare Secondary Payer Reporting

Basic Primary Insurers: Click Mandatory Insurer Reporting for Non-Group Health Plans (NGHP) to access reporting forms related to Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).