Medicare Secondary Payer Reporting

Mandatory Insurer Reporting for Non-Group Health Plans (NGHP)

Complete the following form and submit to Mcare at the same time a medical malpractice liablity payment is reported to CMS based on the requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).

MSP Primary Carrier Reporting Web Form 4.24.2014

Please call Mcare at 717-783-3770 x274 or x257 with questions regarding Mcare's reporting requirements.

Click Mandatory Insurer Reporting for Non-Group Health Plans (NGHP) to access the CMS Mandatory Insurer Reporting for Non-Group Health Plans (NGHP) website.

The purpose of Section 111 reporting is to enable CMS to pay appropriately for Medicare-covered items and services furnished to Medicare beneficiaries. Section 111 NGHP reporting of applicable liability insurance (including self-insurance), no-fault insurance, and workers’ compensation claim information helps CMS determine when other insurance coverage is primary to Medicare, meaning that it should pay for the items and services first before Medicare considers its payment responsibilities.

Reporting is accomplished by either the submission of an electronic file of liability, no-fault, and workers’ compensation claim information, where the injured party is a Medicare beneficiary, or by entry of this claim information directly into a secure Web portal, depending on the volume of data to be submitted. Upon receipt of this information, CMS checks whether the injured party associated with the claim report is a Medicare beneficiary, and determines if the other insurance is primary to Medicare. CMS then uses this information in the Medicare claims payment process and, if Medicare paid first when it should not have, uses it to seek repayment from the other insurer or the Medicare beneficiary.