Employer Group Size Reporting
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:
- Does an employer have less than 20 full-time and/or part-time employees on their “payroll” and are not part of a multi-employer group health plan?
- Does an employer have 20 or more full-time and/or part-time employees on their “payroll” for each working day in each of 20 or more calendar weeks in the current or preceding calendar year? The 20 weeks do not have to be consecutive.
Please complete the Medicare Secondary Payor (MSP) employer group size information below.
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.
Group size form
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