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BN - Medicare Data Match Process (Demand Letters)
This provides guidance on what steps an institution should follow if they receive a Medicare Demand letter.
Background - Centers for Medicare and Medicaid Services (CMS), Benefit Coordination & Recovery Center (BCRC) is the organization that oversees the Medicare Coordination of Benefits.
The first step in the process is the Coordination of Benefits (COB) in which the BCRC works with Employee Trust Funds (ETF) for coordination of benefits to verify if Medicare is the primary or secondary payer.
- IRS-SSA-CMS Data Match questionnaire is sent to ETF to complete coordinating coverage month data.
- ETF responds through a Voluntary Data Sharing Agreement (VDSA) using the Electronic Media process to reply to the questionnaire.
If BCRC determines after reviewing the data from the questionnaire that Medicare should have been the secondary payer, it will forward the claim for collection. A Demand Letter will be sent to the employer (UWSS Service Operations) and the health insurance carrier. We are allowed 60 days to resolve this issue. If the situation is not resolved, a second notice will be sent from the BCRC.
1. If a Medicare Demand letter is received at the institutional level, please forward to the UWSS Service Operations Benefits Team (Tier 3). The UWSS Service Operations will complete the processing. If contacted directly by a health insurance carrier regarding a Demand Letter, please refer them to the UWSS Service Operations Benefits Team.
2. The UWSS Service Operations will complete all remaining tasks related to a Medicare Demand Letter.
If you have any questions regarding this, please contact your AG Group. The contact information is located on the left side of your page.