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TXANS Association of Responsible Nonsubscribers

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Secondary payer provisions are designed to assist the federal government in protecting the financial viability of the Medicare system and affected employers and industry professionals must register on or before September 30, 2009.

Medicare secondary payment requirements have existed since 1980 but new requirements in Section 111 have prompted the Centers for Medicare and Medicaid Services (the administering agency) to establish new tools to govern compliance. Nonsubscriber professionals involved in the payment of claims are responsible for understanding and ensuring compliance and failure to do so can result in significant fines and penalties.

Under Section 111, reporting obligations are the responsibility of the responsible reporting entity or RRE. An RRE can be a nonsubscriber plan, insurer or employer and determining the RRE is generally dependent upon who writes the check to pay a beneficiary’s claim. Claims professionals like third party administrators that oftentimes assist with claims processing generally are not be defined as an RRE.

TXANS would like to thank Chad Farrar, Sue Maraglino and Jon Capps for their assistance with TXANS program on Medicare Secondary Payer Requirements.

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