Updated WCMSA Reference Guide Issued

An updated Worker’s Compensation Medicare Set-Aside (“WCMSA”) reference guide has been issued.[1] The revised guide includes:

  • Fields formerly labeled as “HICN” have been labeled as “Medicare ID” and can accept either Health Insurance Claim Number (“HICN”) or the new Medicare Beneficiary Identifier;
  • The link to the CDC Life Expectancy Table has been updated; and
  • The verifying jurisdiction and calculation method for fee schedule pricing for submitted MSAs has also been updated.

No changes to the life table were made. In regard to fee schedule pricing, it usually depends upon where upon where the worker’s compensation claim is filed, and an updated guide provides an example of how pricing is determined.

The new updates were also accompanied by the release of a revised MMSEA Section 11 Medicare Secondary Payer Reporting Guide. The only change is minor, changing the escalation process, which simply notes a new Electronic Data Interchange support contact. [2]

[1] https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Downloads/WCMSA-Reference-Guide-Version-2_8.pdf

[2] https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/NGHPUserGuideVer54Ch1IntroAndOverview.pdf

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