WCIRS - Medicare Compliance

Medicare Compliance

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), added new mandatory reporting requirements for liability insurance and workers compensation. Insurance carriers, self-insureds, and third party administrators are required to identify Medicare beneficiaries, and report those claims to the Centers for Medicare/Medicaid Services. Essentially, this entails a quarterly EDI feed of claim data including financial summary information. WCIRS supports batch reporting and manual data entry of this information. It also includes a Medicare Beneficiary lookup via the CMS query service, in order to verify which claims must be reported.

WCIRS is an internet-based solution that fulfills state and federal regulations for liability and workers' compensation claims submissions. This solution performs quarterly electronic claims filing with CMS.

GAIN CMS COMPLIANCE QUICKLY AND COST EFFECTIVELY Requirements for CMS reporting may differ from your system’s current capabilities. WCIRS can help by providing the necessary components to gain compliance with minimal time and effort.

Implementation Services

• Workflow analysis
• Data export setup/programming
• CMS Registration Support
• Test phase assistance and certification
• User training

System Features

• Secure login and authentication
• Batch load of claim information
• Automated data edits to ensure mandatory elements
• Manual entry/update of claim information
• Receipt and processing of CMS response
• Beneficiary lookup via CMS Query Service

System Report Examples

• Medicare Beneficiaries List
• CMS Filing Summary
• CMS Filing Detail
• CMS Claims without Response
• CMS Status Summary

For more information about WCIRS, please contact Envision.

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