MSP Update ELCMS User Group 5-11
Contents
1. Medicare Beneficiary but has not yet been reported Set by MSP Candidate Response Import Reported Report has been submitted Set by MSP Claim Export Error Initial or Final report was returned for correction Set by MSP Claim Import Terminated Final report has been submitted Users with permission can select Closed MSP Reporting is closed without reporting Users with permission can select 21 MSP Resources i CHTEPEED DATA SOLUTIONS INC MSP Export Status e Pending Claimant is not yet ready to be reported e Add Claimant is ready to be reported in next cycle e Done Claimant has been reported e Confirm The claim has already been reported and COBC has acknowledged that report was successful e Error Last report resulted in an error that should be corrected before the next reporting cycle e Update Reportable information has changed the update will be reported in next cycle e Del Add Key information i e claim number has been changed and must be reported in special Del amp Add style e Delete User changes MSP Status to Exempt after the claim has already been reported 22 A X LIGHTSPEED DATA SOLUTIONS INC MSP and ELCMS ELCMS User Group Meeting WebEx May 11 2011 Conclusion2. Suffixes Db IClick to jump to claim Includes similar data to what would be reported Added Open and Close dates to results in v5 06 Modified to Two Tier with first tier to be claimant and second tier suffix level in v5 07 MSP Enhancements since 2010 User Group eee eee DATA SOLUTIONS IN e ICD9s Integrated with Bill Review Providers NOINJU ICD9 code a special use value as defined by CMS in a Nov 12 2010 alert Update in v5 04 and again in v5 06 e Imports UDS M Import added in v5 07 MSP TIN Reference Response Import added in v5 07 e Metrics hie M ORM status and TPOC start date added in v5 Exception metric Deceased Claimant without Survivor added in v5 07 MSP Enhancements since 2010 User Group eee eee DATA SOLUTIONS IN e MSP Status Added Closed status in v5 06 Added Confirmed Export Status e Notes System note when Query Process identifies a Beneficiary System note for Claim Report Response indicates Disposition code e ORM Anticipated Termination Date Some funds have a floating ORM termination dates based on the most recent Loss Payment CMS does not allow reporting of termination dates more than 6 mos in the future Users can maintain this as the termination date floats When the date comes within 6 mos they can then enter the appropriate date in the actual Termination Date field MSP Enhan
3. in PDF will soon be available on Lightspeed website CMS Website http Awww cms gov MandatorylnsRep Lightspeed Website htip www lightspeedclaim com Client section NGHP User Guide v3 1 available from CMS or Lightspeed website e New User Guide expected later this month Delayed ELCMS User Manual MSP Enhancement Lightspeed website NCIGF MSP Working Groups e Administrative Laura Keller lakeller state pa us e Technical John Arment JArment mpcga org MSP Compliance Presentation from NCIGF Managers Meeting Fall 2010 DRI Defense Practitioner s Guide to Medicare Secondary Payer Issues USPS Address Lookup http zip4 usps com zip4 welcome jsp 20 MSP Resources i CHTEPEED DATA SOLUTIONS INC MSP Status Exempt Claimant is associated only to Exempt coverages they will be excluded from the E process Defaulted upon suffix creation users with permission can select as an override Nominee Claimant is associated with any Reportable or Conditional coverage but has insufficient info to determine Medicare status Defaulted upon suffix creation users with permission can select as an override Candidate Claimant is associated with any Reportable or Conditional coverage and has sufficient info to determine Medicare status Set by nightly processing Beneficiary Claimant is associated with any Reportable or Conditional coverage there is sufficient data to report and claimant is confirmed to be
4. 2012 Version 2 0 0 effective 1 1 10 was never adopted by ELCMS Discontinued effect 1 1 12 v3 0 0 effective January 1 2012 Export to CMS MSP Candidate Wrapped Export e Recommend this be done on a monthly basis e Could be done quarterly Import from CMS MSP Candidate Response Import e Processing will update any identified MSP Beneficiary to Beneficiary Claimant s MSP Status e Provides the Beneficiary s HICN and will also correct DOB and Gender V 5 07 will include an alert when DOB or Gender is corrected e Production Response is anticipated to take up to 14 days so schedule accordingly It is taking 1 2 weeks as of 1 12 11 z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS INC What needs to be reported e TPOC Total Payment Obligation to Claimant Qualified Medical Payments Settlements e TPOC for No fault and Workers Comp on or after October 1 2010 user Guide v3 1 e TPOC for Liability and Self Insurance on or after October 1 2011 cms siert 11 9 2010 Reported when payment paid or settlement recorded Reporting threshold for TPOC only claims no ORM involved e TPOC date is in 2012 or Before amp amount is 5 000 or less is exempt from reporting e TPOC date is in 2013 amp amount is 2 000 or less is exempt from reporting e TPOC date is in 2014 amp amount is 600 or less is exempt from reporting e TPOC date is in 2015 or after there is no threshold e ORM Ongoing Responsi
5. A X LIGHTSPEED DATA SOLUTIONS INC MSP and ELCMS ELCMS User Group Meeting WebEx May 11 2011 Overview Review Recent and Upcoming M x HT 5 A E E D Enhancements M LI G DATA SOLUTIONS INC Reporting and Best Practices CMS amp UDS Changes Questions and Issues Resources z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS INC e Two Conditions needed to report Who amp What Who needs to be reported e Medicare Beneficiaries Generally those 65 years old or over There are exceptions that could include any age Claimant must be or become a Medicare Beneficiary during the time covered by the TPOC or ORM What needs to be reported e TPOC Total Payment Obligation to Claimant Qualified Medical Payments Settlements TPOC for No fault and Workers Comp on or after October 1 2010 user cuiae vs 1 TPOC for Liability and Self Insurance on or after October 1 2011 cus ser 112010 Generally Reported when settled e ORM Ongoing Responsibility for Medicals ORM pre existing claims prior to January 1 2010 user cuiae vs Excludes ORM closed prior to January 1 2010 User Guide v3 1 Reported when responsibility assumed Reported when responsibility terminated z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS INC Who needs to be reported e Nominee Claimants MSP Status On claims that could be or become reportable Claimants on
6. Process Quarterly Export to CMS MSP Claim Export e Intersect of Who and What Claimant must be a Beneficiary Claim must have TPOC and or OMR to report e Process will update Claimant to Reported MSP Status Will be set to Terminated if final ORM termination has been reported Response Import to CMS MSP Claim Import e If there are no issues with the submitted report no further processing is needed e For any issues the process will update Claimant to Error Claimant s MSP Status e Response is taking 1 2 weeks as of 5 6 11 EDI reps will not intercede within 45 days MSP Enhancements since 2010 User Group LIGHTSPEED fe eae e Alerts New MSP Beneficiary when Candidate becomes Beneficiary in v5 06 Correction to DOB or Gender from the Candidate Response Import in v5 07 New MSP Error Nightly processing performs tests similar to the Test button and re evaluate and remove if corrected Also processed when response files are imported V5 07 e Contacts Supports multiple Attorney Guardian PoA Other e Excel Export Exportxl_spu_coverages provides report of coverages with MSP settings MSP Enhancements since 2010 User Group eee ees DATA SOLUTIONS IN e Exports MSP Claim Export e Queue tab added v5 06 UDS M Export added in v5 07 e History Button MSP Import Export history DbIClk to display detail e Flex Report MSP
7. bility for Medicals ORM pre existing claims prior to January 1 2010 e Excludes ORM closed prior to January 1 2010 Reported when responsibility assumed z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS IN What needs to be reported e Where does data to be reported come from RRE info from Fund Maintenance screen Claimant info including Atty from Claimant tab Claimant Medical from Medical detail on Claimant tab Product Liability from Product Liability detail on Claimant tab On hold Recording Claimant Atty info as well as Guardian or other Representatives Recording Claimant Survivor Beneficiaries entered as separate claimants z i ax MSP Overview Review X LIGHTSPEED E Reporting e TIN File Process Report file is generated using the MSP TIN Reference Export e Only needed at beginning of production reporting unless there is a change to your RRE reporting contact information e Special one time resubmit requirement Do as soon after October 1 2011 as possible Must be completed prior to 4 quarter 2011 Claim report Properly formatted address see Resources for USPS Address Lookup Response Import to CMS MSP TIN Reference Import e New Response file provided by CMS available October 1 2011 e ELCMS will support in v5 07 to be ready for production 8 1 11 z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS IN T Reporting e Claim File
8. cements since 2010 User Group eee eee DATA SOLUTIONS IN e Query Process Automatically wrapped export file e Report Process Exception Report indicates Response Codes from CMS e SSN Validation Added to Test Button in v5 06 e Survivor Support Supports multiple survivors in v5 06 e Statuses Examiner and Manager e TIN Export Added in v5 03b e Test Button False errors were CRO7 amp CC12 corrected in v5 06 MSP Reporting and Best Practices ax X LIGHTSPEED DATA SOLUTIONS IN e Manage by MSP Status Nominee Should be advancing to Candidate overnight unless there is insufficient info Beneficiary This is the Who now the What needs to be managed Error Need to be addressed before next Claim Report Terminated Can be user set once MSP reporting is complete Closed Can be user set if the claim is Closed CMS definition prior to the claimant becoming a Beneficiary Status added in v5 06 MSP Reporting and Best Practices DATA SOLUTIONS IN A X LIGHTSPEED e File handling File locations for Import Export Queue Tabs added for the Imports Exports in v5 06 File History e Claimant Queue view added in v5 06 Do not email files e Claim Report Claim Export modifies data and can not be re exported e Query Do a query every month Continue to Query even Beneficiaries added in v5 06 Beneficiary Lookup Onli
9. ne Query Capability MSP Reporting and Best Practices eee DATA SOLUTION S 1N e Oversight Tools for Examiners and Managers MSP Claimants Queue in Home Tab e indicates non Exempt claimants on claims assigned to Examiner e ORM and TPOC info added in v5 06 Examiner MSP Metric e summarizes their MSP Claimants Queue by MSP Status Examiner and Manager Statuses Excel Export exportxl_spu_msp e Replaced by Flex Report Excel Export exportxl_spu_missingmspdata2 e Replaced by Flex Report and Test Button exportxl_ sou_msp_claim_report e It should take an option general parameter of the iolog if no parameter dump whole table CMS amp UDS Changes A X LIGHTSPEED DATA SOLUTIONS IN e Query Processing HEW 1 0 2 and 2 0 0 will be discontinued and replaced with v3 0 0 effective January 1 2012 e TIN Reference Processing TIN Reference Response file e UDS Processing New UDS M file to Receiver New UDS M file from Receiver MSP Questions and Issues A X LIGHTSPEED DATA SOLUTIONS IN Candidates set back to Nominee due to SSN Files getting lost stuck at COBC Survivor handling for MSP vs Payments to Survivors and reporting to Receivers FIGA TOPC amount without TOPC Date Warning and Test Button support in v5 06 Error 51 even though query reported 01 for the Beneficiary MSP Resources A X LIGHTSPEED DATA SOLUTIONS INC e Resources This presentation
10. suffixes with Reportable or Conditional coverages e Candidate Claimant s MSP Status Set through nightly process Nominee that has necessary data to query e First amp Last Name SSN DOB e Beneficiary Claimant s MSP Status Set through monthly query process e Exempt Claimant s MSP Status Set through nightly process Stops monitoring for the claimant 100 days after conclusion of TPOC and ORM and still not yet a Beneficiary e Will not apply until initial reporting period is past e Reported Report has been submitted e Error Initial or Final report was returned for correction e Terminated Final report has been submitted This is not automatic user with permissions can change to this status once final reporting is complete e Closed MSP Reporting is closed without reporting Added in v5 06 this is not automatic user with permissions can change to this status when the claim is closed prior to the claimant becoming an Beneficiary z i ax MSP Overview Review X LIGHTSPEED DATA SOLUTIONS INC Who needs to be reported e Query Process Utilizes HEW HIPAA Eligibility Wrapper e Candidate Query files are automatically wrapped by ELCMS e Response files must be unwrapped using HEW software prior to import e CMS supports two versions of HEW Version 1 2 0 defined in the original specifications This is the version currently supported by ELCMS To be discontinued effective Jan 1
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