Group Health Plan (GHP) administrators, including third party administrators (TPA’s) utilizing the Quantum Choice core administrative processing platform will now fully comply with Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.
[Medford, Oregon – February 2022] – PLEXIS Healthcare Systems, a leading healthcare payer technology company and innovator in next generation digital core administrative processing solutions, today announced that Medicare Section 111 reporting is now a feature within the Quantum Choice release 2021.3.0.
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan (GHP) arrangements as well as for Medicare beneficiaries who receive settlements, judgments, awards, or other payment from liability insurance (including self- insurance), no-fault insurance, or workers’ compensation.
Quantum Choice has been updated to support Medicare Section 111 reporting transactions by generating and importing Input and Response files for Taxpayer Identification Number (TIN) Reference and Medicare Secondary Payor (MSP) information.
Quantum Choice platform will generate the MSP and TIN files and import response data. The Benefit Contract/Plan/Period features a Section 111 Reporting tab which will hold Benefit Plan Coverage Type and pharmacy information for the MSP Input File submission.
“Third party administrators as well as group health plans that are self-funded can now take advantage of the QC benefit administration and claims management system to enable Medicare to correctly pay for the health insurance benefits of Medicare beneficiaries by determining primary versus secondary payer responsibility.” Said Sean Garrett, Chief Operations Officer for PLEXIS Healthcare Systems. “In alignment with CMS regulations, QC will enable CMS and GHP responsible reporting entities to electronically exchange health insurance benefit entitlement information.”
About PLEXIS Healthcare Systems
PLEXIS Healthcare Systems is a leading payer technology company that delivers trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems around the globe. More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage over 55 million lives in all 50 states and around the globe. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations. PLEXIS Healthcare Systems, an established innovator in digital core administrative processing solutions (CAPS), is featured in Gartner’s Market Guide for U.S. Healthcare Payers’ Core Administrative Processing Solutions (25 June 2019) as a Representative Vendor.