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Employers

Employer Bulletin

All WRS Employers
Vol. 21, No. 8
June 17, 2004

Handling Repayment of Claims Requests from a Medicare Intermediary

The Medicare Data Match project is a federal program requiring employers and health care plans to provide information about specific current or former employees covered under the employer’s health plan. The process involves Medicare contacting employers in those cases where Medicare paid a claim as primary, but later determined that it should have paid as secondary. Employers receiving a formal notification from a Medicare intermediary, or a collection agency on behalf of Medicare, should follow the steps outlined in the Employer Bulletins listed below.

Medicare recently notified affected employers that in order for the insurer to take an active role in resolving the issue, the employer must provide the insurer with a specific authorization form. This authorization form must be included in any communication from the insurer to Medicare. The authorization form must:

  • Include employer’s letterhead
  • Authorize the insurer to resolve the debt on the employer’s behalf
  • Identify the affected member
  • Authorize the Centers for Medicare and Medicaid Services (CMS); its Medicare contractors and their employees and agents; and the Department of the Treasury and its employees, contractors and agents, to disclose for a period of one year any and all information related to a debt identified in a specified Medicare Secondary Payor (MSP) recovery demand letter.

This language has been incorporated into attached Sample Letters A and B, which we suggest using when you respond to the repayment of claims request. Also included in the language is a request that Medicare state in writing to the employer when the matter of the debt is resolved. These updated sample letters are attached.

You can view previous Employer Bulletins on this topic on the Department of Employee Trust Funds (ETF) Internet site, http://etf.wi.gov. Click on the “Employers” tab, then on “All WRS Employers” under Employer Bulletins.

Legal responsibility for these claims lies with the employer. Consequently, ETF has no administrative role in the process. However, we may be able to offer assistance. If you have questions about collection notices and how to handle them, you may call the Employer Communication Center at (608) 264-7900.

Sample Letter A

I am writing in regard to Debt Identification Number ______________ addressed in the enclosed copy of your letter, dated ________________________.

I challenge the assertion that the (Employer Name) owes HCFA $___________. It is my belief that all claims are payable, or have been paid, by (Health Plan Name) (the HMO with whom (employee’s name) had health insurance coverage), or the appropriate carrier; or, the claims are not covered as a primary benefit under the State of Wisconsin group health plan.

(Name of individual and Health Plan) is processing all appropriate claims. You may contact (him/her) at:
(Health Plan Contact Name Plan Name Plan Address)
I hereby authorize (Name of individual and Health Plan) to resolve the debt on the behalf of (Name of employer). I further authorize the Centers for Medicare and Medicaid Services (CMS), its Medicare contractors, their employees and agents, and the Department of the Treasury and its employees, contractors and agents to disclose for a period of one year, any and all information related to a debt identified in a specified Medicare Secondary Payor (MSP) recovery demand letter to (Name of Health Plan).

(Name of Plan Contact)’s phone number is (plan contact’s phone number). If you have any questions, please contact (Plan contact’s name); otherwise, she/he will respond, as soon as is practicable, to specific requirements in your (date) letter.

When this matter is resolved, I request a letter from the Centers for Medicare and Medicaid Services (CMS) stating that the debt is closed.

Sincerely,
Enclosure
cc: (Plan Contact Name/Plan)
Bill Kox, Dept. of Employee Trust Funds


Sample Letter B

On (date), we received a Formal Notification in regard to Debtor ID# __________. A copy of the Formal Notification dated (date) is enclosed.

Upon calling your office, we were advised that this Debtor ID# related to Medicare payments on behalf of (employee’s name).

This letter is to advise that the (employer name) did not receive the first notice regarding this claim from HCFA as part of the Medicare Data Match process. Also, (employer name) did not receive the second notice of such claim, which is generally sent one year after the first notice, providing the employer an opportunity to respond with 30 days.

Therefore, I am requesting that you provide to (employer name) any and all documentation on this claim including the name of the Medicare Intermediary. This documentation must contain all of the information that would have been originally provided by HCFA when submitting the first notice to (employer name). The documentation can be sent to:

(Your name and address)

I challenge the assertion that (employer name) owes HCFA $___________. It is my belief that all claims are payable, or have been paid, by (Health Plan) (the HMO with whom (employee name) had health insurance coverage), or the appropriate carrier; or, the claims are not covered as a primary benefit under the State of Wisconsin group health plan.

Should you want to contact (health plan), (health plan contact name) is handling this situation. Mr./Ms. (name)’s address is (address of health plan). I hereby authorize (Name of individual and Health Plan) to resolve the debt on the behalf of (Name of employer). I further authorize the Centers for Medicare and Medicaid Services (CMS), its Medicare contractors, their employees and agents, and the Department of the Treasury and its employees, contractors and agents to disclose for a period of one year, any and all information related to a debt identified in a specified Medicare Secondary Payor (MSP) recovery demand letter to (Name of Health Plan).

When this matter is resolved, I request a letter from the Centers for Medicare and Medicaid Services (CMS) stating that the debt is closed.

Sincerely,
Enclosure
cc: (Health Plan contact name and plan)
Bill Kox, Department of Employee Trust Funds
US Department of Treasury–FMS