CMS Query for Section 111 Reporting

Posted date in Jason D. Lazarus, J.D., LL.M. Medicare, Medicare Secondary Payer Act, MMSEA, MSP Compliance

Medicare has set up a query system for insurers to verify Medicare entitlement so they can comply with the Section 111 MMSEA mandatory insurer reporting requirements.  In my opinion, the information that is necessary to the query should be provided to the defense so at least confirmation of Medicare entitlement can be verified.  The information that is needed for the query is the client's SSN or Medicare Health Insurance Claim Number (HICN), name, date of birth and gender of the injured party.

CMS has created a sample form for defendants to use in requesting this information.

Defendants are using Section 111 Mandatory Insurer Reporting as means to discover information they don't need for reporting.  Any discovery beyond the scope of the info described above is unnecessary for the reporting and probably is objectionable.