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As your insurer, HAP is required by law to report group eligibility data to Centers for Medicare and Medicaid Services (CMS). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees the Medicare program. Many Medicare beneficiaries have other private group health plan (GHP) insurance in addition to their Medicare benefits. There are federal rules that determine whether Medicare or the other GHP insurance pays first. We need to work together to meet the obligations of the Mandatory Insurer Reporting for Group Health Plans, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). This reporting is to assist CMS and HAP to properly coordinate payment of benefits so that claims are paid promptly and correctly. For further guidance on the requirements, please reference the CMS website.
Medicare secondary payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first. The MSP requirements for Working Aged and Disability require information on employer size to determine the correct primary payer. Employer size is based on the number of employees, not the number of individuals covered under the Group Health Plan. Under the MSP provisions, an employee is an individual who works for an employer, on a full or part-time basis, and receives remuneration for their work. This includes anyone for whom a W-2 form was filed under the Employer Identification Number (EIN)/ Federal Tax ID, including intermittent and/ or seasonal employees.
Employer group size is determined by answering the following questions:
It's important to report changes in your employer group size that may impact the coordination of benefits. We strive to help our clients by directing them to information that may be helpful. If you have questions or need assistance determining your employer group size, please refer to the CMS website.
This resource provides Medicare regulations that affect employers and will assist you with meeting your responsibilities and obligations under the Medicare Secondary Payer (MSP) laws. HAP does not provide legal or human resources advice. If you have further questions, we encourage you to consult with an attorney or human resources professional.
Welcome to HAP Empowered! During this webinar, you’ll: Get to know your Medicaid plan. Learn how to get the most out of your coverage.