The first step in defining your primary payer responsibilities throughout your claim.
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) requires responsible reporting entities (carriers, self-insureds, and third-party administrators) to report claims involving Medicare beneficiaries to CMS. It sounds routine, but the details carry real consequences: the data an RRE reports is exactly what CMS uses to pursue conditional payment recovery. Over-inclusive or inaccurate reporting (the wrong ICD codes, body parts that were never part of the claim) directly inflates what Medicare tries to recover later. Getting the reporting right is the first line of defense against paying more than you owe.
Full-service agent or advisory oversight.
For clients who want it fully handled, we serve as your reporting agent, preparing and transmitting your quarterly files to CMS, managing ORM and TPOC reporting, and resolving the error and response files that come back.
For clients who report on their own or through an existing agent, we work in an advisory and coordinative role, auditing what's being reported, correcting ICD and relatedness coding, and making sure your reporting reflects the true scope of the claim.
Reporting and conditional payment services work hand in hand.
Our reporting work is closely coordinated with our conditional payment resolution. Because the two are really one problem viewed from two ends, we keep them aligned: the relatedness findings that lower a conditional payment demand feed directly back into cleaner, more accurate reporting, and accurate reporting keeps future recovery claims from ballooning in the first place. That coordination is where a lot of exposure quietly gets eliminated, and it's where working with a single team across both functions pays off.
Want to talk about a file? Refer a case.
Triage response within one business day.