New Medicare Secondary Payer Reporting Requirements

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (the "Act") will require group health plan insurers, third-party administrators, and some plan administrators and fiduciaries to comply with new Medicare Secondary Payer ("MSP") reporting requirements effective January 1, 2009.

MSP rules dictate whether a group health plan or Medicare is primary when an individual has coverage from both sources. In general, a group health plan pays primary for coverage due to current employment status and secondary to Medicare for retiree coverage. Special MSP rules apply to individuals who have end stage renal disease.

Under the Act, a group health plan's insurer or third-party administrator ("TPA") or, in the uncommon situation of a self-funded and self-administered plan, the plan administrator or another plan fiduciary must: