MedicareConnectSM Mandatory Insurer Reporting Solution
Mandatory Insurer Reporting (MIR) is one of the most critical compliance issues for the workers’ compensation and liability industries today. As an industry leader in innovative solutions for Medicare Secondary Payer (MSP) compliance, PMSI provides a comprehensive solution for MIR with MedicareConnect. Designed as a scalable solution, MedicareConnect offers three tiers of claims submission options:
- Electronic – all CMS-required attributes are submitted using PMSI’s proprietary XML file format or UFF for direct data import.
- Hybrid – fields available from the client’s source claim system are transmitted via an electronic XML feed. Additional fields are entered via the MedicareConnect online portal.
- Manual – all required reporting attributes are entered manually through the MedicareConnect portal.
Efficient Error Handling
MedicareConnect provides users with multiple views of claim status and associated errors. An easy-to-read dashboard allows users to quickly view the status of all claims and level of risk. Red, amber and green signals provide visual direction to the oldest claims.
Advanced Data Validation and Management Capabilities
The MedicareConnect system contains an advanced library of MMSEA Section 111 regulatory business rules that are consistently reviewed and maintained by PMSI's regulatory specialists. Each claim is validated on entry, when there is an update by the client, or through interaction with CMS. Utilizing threshold verification on claims, MedicareConnect prevents over-reporting of claims, allowing the user to focus only on those claims that need to be reported.
Insightful Reporting Functionality
Through PMSI's VitalPointTM reporting portal, MedicareConnect users can access robust reports that provide summary and claim details throughout the lifecycle to help optimize the claims management workflow. Executive- and management-level compliance reports provide critical data for business strategy.
MedicareConnect is the most reliable and flexible platform available to help Required Reporting Entities (RREs) manage claims through the MIR process. A proven solution for compliance, MedicareConnect has achieved a 99.9% acceptance rate on submissions to CMS.