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Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward



  • Changes influencing Medicare Secondary Payer compliance go into effect April 1, 2019

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    | May 16, 2019
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    Medicare Secondary Payer, Medicare Insights
    In accordance with the SSN Fraud Prevention Act of 2017, the COB&R program will mask the SSN and SSN-portion of the HICN, on all outgoing letters as of April 1, 2019.


  • Brand medication increases and generics for release in 2019

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    | May 15, 2019
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    Medicare Secondary Payer, Generics, Medicare Insights, medicareinsights blog
    As an established Medicare Secondary Payer (MSP) compliance services provider, one of our goals is to keep clients, and the property and casualty insurance industry, informed of changes affecting MSP compliance and Workers’ Compensation Medicare Set Asides (WCMSAs). As part of our best business practices, we continually monitor the RED BOOK® Average Wholesale Price (AWP) changes of the most common medications in WCMSAs as well as generic medications that come to market. This practice assists in identifying price changes that affect WCMSAs.


  • CMS releases NGHP Section 111 User Guide Version 5.5

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    | May 15, 2019
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    Medicare Insights, CMS
    As an established Medicare Secondary Payer (MSP) compliance services provider, one of our goals is to keep clients, and the property and casualty insurance industry, informed of changes affecting MSP compliance. On January 4, 2019, CMS released an updated Non Group Health Plan (NGHP) User Guide, version number 5.5.


  • Version 2.9 of the Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide released

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    | May 15, 2019
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    Medicare Set-Aside, workers compensation, Medicare Insights, WCMSA
    On January 4, 2019, The Centers for Medicare and Medicaid Services (CMS) released an updated Workers Compensation Medicare Set-Aside (WCMSA) Reference Guide, Version 2.9. One of the major updates in Version 2.9 is additional language regarding justification for inclusion of Lyrica® in WCMSAs.


  • Medicare’s coordination of benefits energizes prescription Part D Plans to recover conditional payments

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    | May 15, 2019
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    Medication Plans, Medicare Advantage Plans, Medicare Insights
    We have observed an increase in notices being provided to workers’ compensation, no-fault auto and premises coverages, liability insurers, and claimants in recent months requesting information so that coordination of benefits (COB) can occur for claimants who are current Medicare beneficiaries. In an effort to get to the bottom of the frequency of these inquiries, we began a search into the recent probing efforts by the BCRC, Medicare Advantage plans (MAP), and Medicare prescription Part D plans.


  • Over $100 billion in Medicare savings attributable to Medicare Secondary Payer Act

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    | May 15, 2019
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    CMS, Medicare Insights
    The Medicare Secondary Payer Act turns 38 years old in December 2018. While it’s credited with saving more than $100 billion in taxpayers’ money since 1999, it’s not without its critics. The MSP Act was passed to protect the Medicare fund from paying claims that are the responsibility of other payers. From its inception, Medicare was designed to be a “secondary payer” to workers compensation, auto, liability, and no-fault primary or other obligated payers. However, it didn’t take long for the system to figure out that Medicare was paying for medical care related to claims that other payers were responsible for.


  • A Formal Review Program for Liability/No Fault MSAs Is Back

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    | May 15, 2019
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    WCRC, Medicare Insights, MSA
    As anticipated, implementation of a formal voluntary Liability Medicare Set-Aside (LMSA) and No-Fault Medicare Set-Aside (NFMSA) review program is at the forefront once again. A proposed rulemaking, Miscellaneous Medicare Secondary Payer Clarifications and Updates, has been posted by the Office of Management and Budget, which states that A Notice of Proposed Rulemaking (NPRM) will be issued by September 2019.



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