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Optum is PAID Act compliant and delivers customized access to data

January 4, 2022 · Medicare Insights Team

One year after it was signed into law, the Provide Accurate Information Directly ("PAID") Act went live on December 11, 2021. The Act requires the Centers for Medicare & Medicaid Services (CMS) to expand its process to identify whether a claimant is currently or has– in the last three years– been enrolled in Medicare Part C and/or Medicare Part D coverage. With this information, insurers can better identify a claimant’s Medicare plans and avoid unnecessary litigation.

The Optum Settlement Solutions team has been diligently monitoring the trajectory of the PAID Act and has updated our processes, portal and Section 111 reporting capabilities to capture the Medicare Part C and D data. This work helps ensure that the Optum Medicare Secondary Payer (MSP) compliance program – and our clients – are fully compliant with the PAID Act.

In response to the PAID Act:

  • We are receiving Medicare Advantage Plan – Part C (MAP) and Prescription Drug Plan – Part D (PDP) information from CMS and passing it to our clients.
  • Clients can load data directly to their claim systems or use our MedicareConnect℠ platform to view individual claims or their entire book of business.
  • Reports can be customized down to the adjuster level as part of the claim handing process.
  • We query for MAP and PDP monthly to ensure the up-to-date information when settling claims.
  • Optum stores data for life of the claim and will be able to provide plan data beyond 3 years. 

The purpose of Section 111 reporting
Timely and accurate Section 111 reporting ensures that Medicare does not pay for services and treatments associated with claims where another entity has primary payer responsibility for the Medicare beneficiaries’ claim. As an industry leader, Optum and our MedicareConnect℠, data validation rules, Settlement Referral and Reporting Tools portals, help clients.

  • Manage and access their Section 111 Reporting data
  • Achieve Conditional Payment resolution and Medicare Set-Aside approvals
  • Monitor the clinical appropriateness of current and future pharmacy, ancillary and medical treatments for an injured person
  • Manage MSP compliance
  • Achieve cost containment

With Optum, you don’t have to choose between compliance and cost savings, you can have both.

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