Changes to MMSEA § 111 Reporting Requirements for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation Responsible Reporting Entities (RREs)

The Centers for Medicare and Medicaid Services (“CMS”) have tapered some reporting requirements for batch file submissions and Direct Data Entry reporters, effective April 22, 2013. In an alert issued this week, CMS notified users that two fields in on-line reporting forms will be considered optional rather than required. The changes affect fields for alleged cause of injury and identification of representatives of deceased parties.

“Alleged Cause of Injury, Incident or Illness”

First, the “Alleged Cause of Injury, Incident or Illness” field on the Claim Input File Detail Record will change from required to optional. Previously, users were required to supply an ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) External Cause of Injury Code describing the alleged cause of injury or illness. No change is being made to the requirement that at least one ICD-9-CM Diagnosis Code be submitted in Field 19.

Bottom Line
Beginning April 22, Responsible Reporting Entity (“RRE”) submissions will not have to identify the cause of the injury. The ICD-9 codes describing the injury will continue to be mandatory in fields 19 through 55, but the description of the injury in field 15 will be optional.

Claims Involving a Deceased Primary Injured Party

The second change involves information that a claimant or claimant’s representative must submit if the primary injured party is deceased. Currently, in these cases claimants or their representatives must identify their relationship to the deceased party (such as estate or family member), the claimant’s tax ID number, and the claimant’s name and contract information. As of April 22, 2013, claimants will have the option of submitting this information, but will no longer be mandated to do so. Additionally, if the claimant is represented, RRE’s must currently report the scope of the representation (i.e. an attorney, guardian, or power-of-attorney), and the representative’s contact information.

Bottom Line
RREs will no longer be required to obtain the information on the estate or family member bringing the suit. Since the claimant will no longer be required to provide a tax identification number, the reporting process should be less adversarial as parties will not need to request as much personal information.

Click here to read the full alert on the CMS website. If you have questions or need additional information, please contact Marlene Wilson at Garretson Resolution Group at 704-559-4300 or at mwilson@garretsongroup.com.