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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

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...
July 27, 2020 · Lavonya Chapman, Associate General Counsel, Optum Settlement Solutions
The U.S. Circuit Court of Appeals recently ruled that Medicaid may seek to recover payments it made for an eligible recipient’s treatment from the settlement agreement that released both past and future medical care ― Gallardo v. Dudek, 2020 U.S. App. LEXIS 19928. The 11th Circuit used the U.S. Supreme Court’s decision in Arkansas Dept. of Health and Human Svcs. v. Ahlborn, 547 U.S. 268 (2006) in reaching the Gallardo decision. Read more...
July 22, 2020 · Lavonya Chapman, Associate General Counsel, Optum Settlement Solutions
The Centers for Medicare and Medicaid Services (CMS) recently alerted stakeholders that they updated the requirements for reporting auto no-fault claims in the Non-group Health Plan (NGHP) Section 111 User Guide. This update affects responsible reporting entities (RRE) and associated third-party claims administrators (TPA) who insure or manage No-Fault auto claims and are required to report to CMS under the Medicare Secondary Payer (MSP) Mandatory Reporting Provisions Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007. Read more...
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