PAID Act Technical Alert Issued
Today, the Centers for Medicare & Medicaid Services (CMS) issued its first technical alert relative to the Provide Accurate Information Directly (PAID) Act. The alert states the following:
On December 11, 2020, the Provide Accurate Information Directly (PAID) Act was signed into law, with the intent to help Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) better coordinate benefits by providing additional beneficiary enrollment information. Prior to the PAID Act, there was no reliable method for an NGHP RRE to identify if a beneficiary was enrolled in a private Medicare Advantage (Part C) or Prescription Drug (Part D) Plan. The PAID Act requires that CMS provide the NGHP RREs with a Medicare beneficiary’s Part C and Part D enrollment information for the previous 3 years. Effective December 11, 2021, this additional information will be provided via new fields in the NGHP Section 111 Query Response File. Information returned will include the Contract Number, Contract Name, Plan Benefit Package Number, Plan address, and effective dates for the previous 3 years (up to 12 instances each for Part C and for Part D). CMS will also be including the most recent Part A and Part B entitlement dates. As part of the PAID Act, the HIPAA Eligibility Wrapper (HEW) application, both the Windows and mainframe versions, will be modified to accept new information in the NGHP 271 X12 file format and convert it to a fixed-length S111 Query Response flat file.
Because of the significance of the change to the query response record and to ensure that RREs are prepared for these changes, CMS will be supporting a testing period beginning September 13, 2021. At that time, a new version of the HEW application will be available to allow RREs to test with the new query response record format. More information on testing periods will be made available in future announcements.
Details on the Section 111 NGHP Query Response File Layout changes are available in Version 6.4 of the NGHP User Guide. Information on changes to the HEW software is available in Appendix K of Version 6.4 of the NGHP User Guide as well as in Version 5.5 of the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities. These user guides are available on the NGHP User Guide page on CMS.gov.
Commentary:
CMS is clearly standing ready to implement PAID Act on time by December 11, 2021, by releasing this Technical Alert several months in advance. Additionally, as mentioned in our prior blog, CMS will be hosting a webinar on PAID Act on June 23, 2021, in which Responsible Reporting Entities (RREs) and Reporting Agents will learn more about the implementation of PAID Act and be able to ask questions about new procedures once PAID Act is implemented. Sanderson Firm will attend the webinar and provide any relevant updates. Lastly, it is highly suggested that RREs take advantage of the testing period for PAID Act which is noted in this Alert to begin September 13, 2021.
The last noteworthy point is CMS acknowledging within this Technical Alert that “Prior to the PAID Act, there was no reliable method for an NGHP RRE to identify if a beneficiary was enrolled in a private Medicare Advantage (Part C) or Prescription Drug (Part D) Plan.” As a fierce advocate for the PAID Act over the last several years and as I have written about on numerous occasions, entities such as MSP Recovery LLC have been filing unfair double damages lawsuits for alleged unreimbursed conditional payments that in most of the occasions the primary payer had no notice of the demand for reimbursement before being hit with a lawsuit. Additionally, the primary payer most often had no notice or awareness of the injured party’s enrollment in a Medicare Advantage or Part D plan at all. There has been no reliable method to identify an injured party’s enrollment in these plans prior to the PAID Act; thus, it is appreciated for CMS to acknowledge this historical transparency discrepancy.
Contact us with any questions on the PAID Act.
