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CMS releases technical alert change to workers’ compensation reporting
March 11, 2024 · Medicare Insights Team
On February 23, the Centers for Medicare and Medicaid Services (CMS) released a technical alert notifying all concerned parties of upcoming changes to Mandatory Insurance Reporting (MIR) effective April 4, 2025. These changes affect how Responsible Reporting Entities (RREs) report workers compensation claims to Medicare. Prospectively, from April 4, 2025, CMS will require RREs reporting Total Payment Obligations to Claimant (TPOCs) dated April 4, 2025, and after an additional requirement to advise CMS of Workers’ Compensation Medicare Set-Asides (WCMSA) arrangements. A copy of the technical alert can be accessed at the CMS website.
This topic was originally discussed at a CMS webinar held on November 13, 2023. Protecting Medicare Secondary Payer status pursuant to U.S.C. 1395y(b)(8)(ii), CMS will expand the reporting process to capture the WCMSA arrangements.
New fields to report WCMSA
- MSA Amount – dollar amount of the MSA for structured settlements or annuities
- MSA Period – number of years the MSA is expected to cover the beneficiary
- Lump Sum or Structured/Annuity Payout Indicator – designates the MSA as a structured/annuity or lump sum
- Initial Deposit Amount
- Anniversary (Annual) Deposit Amount – if applicable
- Case Control Number – case ID for WCMSAs submitted pre-settlement for voluntary review or for non-CMS approved WCMSAs submitted post-settlement
- Professional Administrator EIN – if applicable.
In order to maintain the existing file structure, CMS has designated a stretch of filler space in the MIR specification to position these fields.
Twelve new error codes
The structure of the MIR response file will not change.
| Error code | Error description |
|---|---|
| CW01 | Non-Numeric MSA Amount |
| CW02 | Non-Numeric MSA Period |
| CW03 | MSA Period is required when MSA Amount is > $0 |
| CW04 | Invalid WCMSA Payout Indicator |
| CW05 | Non-Numeric Initial Deposit Amount |
| CW06 | Non-Numeric Anniversary Deposit |
| CW07 | Zero Anniversary Deposit Invalid when Structured/Annuity Indicated |
| CW08 | CCN Not Found |
| CW09 | EIN Not Found |
| CW10 | MSA Amount = $0 but WCMSA Detail Information provided |
| CW11 | MSA Amount Provided but TPOC Amount 1 Not Provided |
| CW12 | Deposit Amounts are invalid when WCMSA Payout Indicator = ‘L’ |
Next steps
- CMS will provide additional information in the April 2024 Section 111 NGHP User Guide.
- Start assessing resources to incorporate these changes into your MIR reporting.
- Testing with CMS will be available beginning October 7, 2024
Optum can help assist with your Section 111 reporting needs
As a trusted Section 111 reporting agent for many companies, Optum is eager to help with your Section 111 reporting needs and in navigating CMS’ evolving requirements in this area. Our Section 111 reporting experts can ensure that your compliance needs are met.
For additional information, please contact Michael Flower, Optum MSP Compliance Counsel, at michael.flower@optum.com (p) 813-627-2406.
