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Employers

Employer Bulletin

All Employers
Vol. 17, No. 5
March 8, 2000

Medicare Data Match - How to Handle a Request for Repayment of Claims By Medicare

Employer Bulletin Vol. 16, No. 13, dated September 20, 1999 provided the Part II forms of the Medicare Data Match Project to state agencies and local governments participating in the group health insurance program. As you may recall, the Medicare Data Match Project is a federal program that requires employers and health care plans to provide information about specific former or current employes covered under the employer's health plan.

Medicare, administered by the Health Care Financing Administration (HCFA), may have asked you questions regarding the health insurance coverage and employment status of certain former or current employes. By cross checking dates of coverage and employment, Medicare may pursue recovering some of these benefits.

You may be contacted in writing by a Medicare Intermediary (i.e., WPS, Blue Cross Blue Shield, etc.) for the repayment of claims for a former or current employe if Medicare paid as the primary carrier when, in fact, the employer's group health plan was the primary carrier.

Should you receive such a request, please follow these steps:

  • Verify that the employe(s) was identified to HCFA through a data match request as having coverage as or through an active employe.
  • Once the information is verified, forward the letter from the Medicare Part A Intermediary to the applicable health plan for handling.
  • Attach the enclosed transmittal memo from ETF to the affected health plan. The transmittal memo explains the situation to the plan and advises the plan to handle the repayment request. You must complete the information at the bottom of the transmittal memo before sending it to the plan.

ETF has no specific role in coordinating this effort. Please direct your questions concerning the data match directly to Medicare's toll free number at (800) 999-1118.

 

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