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
Should you receive such a request, please follow these
- Verify that the employe(s) was identified to HCFA through a
data match request as having coverage as or through an active
- Once the information is verified, forward the letter from the
Medicare Part A Intermediary to the applicable health plan for
- 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.