MMSEA Section 111 Mandatory Insurer Reporting

Compliance with the Medicare Secondary Payer (MSP) Act and the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) is critical to successful mass tort claims administration. Under these federal statutes, Responsible Reporting Entities (RRE) are required to determine whether a claimant receiving a settlement, judgment, award payment, or other compensation from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation insurance is a Medicare beneficiary. This process helps identify and protect the interests of Medicare beneficiaries, ensures proper coordination with any payer MSP requirements, and supports adherence to broader Medicare Medicaid and SCHIP rules.

The Non-Group Health Plan (NGHP), also known as the RRE or reporting entity RRE, must report claim information to Medicare if the claimant is Medicare enrolled. Failing to provide this information can lead to severe monetary penalties for the insurer or self-insured that does not follow these federal laws and guidance—particularly where Medicare Medicaid Schip considerations apply. Epiq serves as the MMSEA Mandatory Insurer Reporting Agent for companies of all sizes, acting as a responsible reporting entity partner. Our proprietary web-based reporting solution allows clients to securely report claims as required under the MMSEA and extension MMSEA guidelines, thus ensuring compliance with services CMS, reducing the risk of penalties, and facilitating clear coordination benefits among health plans.

In 2024, where both parties to a mass tort settlement have a responsibility under federal law to ensure Medicare reports are sent and repayments completed, collaboration is key. Having a claims administrator who can navigate all parties through Section 111, the MSP, and medicaid schip extension requirements is a must to ensure the walking away rights of both parties are protected. When an injured party Medicare beneficiary is involved, this is especially important to avoid insurance fault disputes and uphold mandatory reporting requirements under the centers Medicare Medicaid framework.