Special Note! Before creating any files, each company will also need to identify the coverages that have Medicare liability. Once these coverages have been identified, Insuresoft must deliver a script to update the medicare_liablity field in the CoverageCodeVersion table. This is very important, because the query file will only request the status on claimants added after the reporting date (01/01/2010) or prior to that date if they have an open loss reserve on Medicare liability coverage.
Also, you must have the authority,"Create Medicare Query File," (Diamond Administration group) to access and run this process.
This function is used to gather information on any claimants added after 01/01/2010 or that were added after 12/05/1980 and have open loss reserves and that have not already been identified as a Medicare Recipient.
To access this function:
Click Administration / Claims / Create Medicare Query File.
When the Medicare Query Response screen displays:
Select Create Query File.
The query starts. As it processes, it gathers any claimants that have been added after 01/01/2010 or that were added after 12/05/1980 and have open loss reserves and that have not already been identified as a Medicare recipient.
Information from these claimants is used to create the query file that can be submitted to CMS (Center for Medicare and Medicaid Services) to determine if the claimant is a Medicare recipient.
A validation that the file has successfully been created is presented when the process finishes. Click OK.
Once the file has been generated, the user needs to retrieve the file from the system setting location (defined above) and convert the file to ANSI X12 270/271 format. During registration you can indicate to use the HEW software provided by CMS. (Note: Please see the CMS user guide for additional information on the HEW Software. This can be found at the following link: www.cms.hhs.gov/MandatoryInsRep.)