TN 1 (11-10)

GN 03316.155 Disclosures to Medicare Set-Aside Companies with Consent

A. Background

Medicare set-aside companies request Medicare and benefit entitlement information from our records to assist insurance carriers, third party administrators, self-insured companies, and attorneys in complying with Medicare Secondary Payer (MSP) laws. MSP laws protect Medicare’s interests in workers’ compensation settlement cases. Medicare set-aside companies use the information they request to help Medicare determine settlement amounts in cases involving future medical and drug-related expenses. We may only disclose information to Medicare set-aside companies with proper consent.

B. Fee charging for non-program related requests

We consider requests from Medicare set-aside companies as non-program related requests. Therefore, we must charge and collect fees prior to disclosing any information. Some companies may insist that the requested information relates to administering Medicare or workers’ compensation programs. Nonetheless, Medicare or worker’s compensation programs are third party private commercial entities, which are not directly responsible for administering health and income maintenance programs under the Social Security Act. Medicare set-aside companies act as advocates for attorneys, carriers, and claimants in coordinating workers’ compensation and Social Security, Medicare, and Medicaid benefits. As such, we must charge fees for providing the requested information.

C. Requests for queries from Medicare set-aside companies

We do not provide queries of any type, including TPQYs, for requests from Medicare set-aside companies. Medicare set-aside companies usually request limited data. We may only provide a query output if the consent document authorizing disclosure specifies every piece of information on the query.

D. References

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GN 03316.155 - Disclosures to Medicare Set-Aside Companies with Consent - 11/12/2010
Batch run: 11/12/2010