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Through an integrated medical, pharmacy, claims and legal approach, we deliver insights to help navigate the ever‑changing Medicare Secondary Payer landscape.

Recent blog posts

February 10, 2021 · Medicare Insights Team
A lower price is now available for a common workers’ compensation medication as its brand alternative hit store shelves in January. Amitiza® is approved by the U.S. Food and Drug Administration (FDA). Read more...
January 06, 2021 · Settlement Solutions Team
To help our clients achieve the lowest possible Workers’ Compensation Medicare Set-Aside (WCMSA) allocations, Optum continually monitors the average wholesale price (AWP) of the most common medications seen in a WCMSA. The following outlines the most recent price decreases for a few of these medications. Read more...
December 21, 2020 · Lavonya Chapman, Associate General Counsel of Optum Settlement Solutions
The recently enacted Provide Accurate Information Directly (PAID) Act will make it easier to determine whether payments for claimed injuries/illness involving workers’ compensation, no-fault and/or liability claims were made by traditional Medicare and/or a Medicare Advantage (Part C) plan (MAP) and/or a prescription Part D plan (PDP) and whether they need to be reimbursed. Read more...
December 07, 2020 · Lavonya Chapman, Esq, RN, CMSP, Associate General Counsel, Optum Settlement Solutions
On November 12, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a Technical Alert and published version 6.1 of the Non-Group Health Plan (NGHP) Section 111 User Guide. Both note changes that will eventually impact Civil Money Penalties (CMP) involving Section 111 reporting when CMS error tolerance thresholds are exceeded. Read more...
November 05, 2020 · Optum Workers' Comp and Auto No-fault
During the recent National Alliance of Medicare Set-Aside Professionals (NAMSAP), now known as the National Medicare Secondary Payer Network, annual conference, John Jenkins, Health Insurance Specialist, Division of Medicare Secondary Payer Program Operations, Office of Financial Management for the Centers for Medicare and Medicaid Services (CMS) provided information on the appropriate method for calculating seed money for annuities involving a Workers’ Compensation Medicare Set-Aside (WCMSA) within the total settlement amount. Read more...
October 28, 2020 · Optum Workers' Comp and Auto No-fault
The RED BOOK® September 2020 update indicated Major Pharmaceuticals recently discontinued their formulation of tizanidine 4 mg tablets. Read more...
October 20, 2020 · Optum Workers' Comp and Auto No-fault
The National Alliance of Medicare Set-Aside Professionals (NAMSAP), now known as the National Medicare Secondary Payer Network, continues to hit it out of the park at their annual conference. Read more...
October 09, 2020 · Optum Workers' Comp and Auto No-fault
The Centers for Medicare and Medicaid Services (CMS) released Version 3.2 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, which clears up how pricing is determined for services rendered at a major medical center. Read more...
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