Section 111 PAID Act Updates

On September 9, 2021, CMS hosted another webinar to discuss upcoming changes to the Section 111 query process.  These changes are being made to comply with the provisions of the PAID Act which requires CMS to provide enrollment information for Medicare Part C and Part D plans.  The following are some of the key highlights from this webinar. 

  • The PAID Act testing period went live on September 13, 2021 and the latest version of the HEW software (v5.0) can now be downloaded for testing purposes.  Reporting entities can still run HEW 4.0 software alongside the 5.0 version to continue their current query process. 
  • You can find additional testing resources including a sample NGHP X12 271 Query Response File and a test beneficiary list under the Reference Materials section once you log in to the Coordination of Benefits Secure Website (COBSW).  
  • Beginning December 12, 2021, RREs will need to switch to the HEW 5.0 software if they want to receive the additional data fields with the Part C and Part D plan information on the query response file.  Version 4.0 will still produce a valid query response file after this date, but it will not include Part C and D results. 
  • Effective October 4, 2021, CMS will update the COBSW so that the Beneficiary Lookup function will return the additional Part C and D information.  If there are no occurrences of Part C and D enrollment in the past three years, the screen will display the message “No Records Found.”
  • Additional information regarding these technical updates can be found in the NGHP User Guide, version 6.4 including Chapter V, Appendix K and the PAID Benefits Coordination & Recovery Center (BCRC) 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 5.7 which can be accessed here.

Responsible Reporting Entities (RREs) are now left with the decision of whether they want to receive important information regarding Part C and D Medicare eligibility or if they will continue their current process after December 12, 2021.  Part C and Part D plans have continued to be more aggressive in their recovery efforts against RREs.  The ability to easily access plan detail information may help prevent additional costs and double damages down the road.  However, just having this information is not enough.  RREs will also need to determine how they want to utilize and address potential Part C and Part D recoveries as part of their claims and settlement process.

For more information on how we can assist you in your Section 111 Reporting needs or with conditional payment resolution and mitigation, please contact the NuQuest Settlement Consultant Team at [email protected].