Guide to MMSEA Key Terms and Acronyms

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Authorized representative
• Individual in the RRE organization with legal authority to bind company
• Designates the Account Manager

Account designee
• Assists the Account Manager
• Can be an RRE employee or agent

Account Manager
• Administers RRE’s account and reporting process
• Can be an RRE employee or agent

CMS – Centers for Medicaid & Medicare Services
• Federal agency responsible for administering Medicare, Medicaid and SCHIP

COB – Coordination of benefits
• Process to identify primary payers to Medicare for the health benefits available to a Medicare beneficiary and to coordinate the payment process

COBC – Coordination of Benefits Contractor
• Identifies primary payees
• Updates databases
• Assigns EDI representative

COBSW – Coordination of Benefits Secure Website

DCN – Document control number
• Generated by the RRE
• Can be any format as long as it is not more than 15 characters

DOI – Date of Incident (as defined by CMS)
• Automobile wreck – date of accident
• Exposure claims – date of first exposure
• Ingestion claims – date of first ingestion
• Implant claims – date of the first implant

EDI – Electronic Data Interchange

FCC – Future cost of care analysis
• Assessment of current and future needs and associated costs to cover those needs over the claimant’s life time

HEW – Health Insurance Portability & Accountability Act of 1996 Eligibility Wrapper

HICN – Health insurance claim number
• Issued to Medicare recipients

ICD9 Codes – International Classification of Diseases, Ninth Revision, Clinical Modification
• Codes that must be used to describe the injury, incident or illness

Medicare – provides Health insurance for:
• people age 65 or older
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant
• Four different coverage types:
o Medicare Part A – Hospital insurance (premium free)
o Medicare Part B – Supplemental medical insurance (additional premium)
o Medicare Part C – Alternative health plans placed with an insurance company which can replace Part A and B (additional premium)
o Medicare Part D – Drug coverage (additional premium)

MMSEA – Medicare, Medicaid & SCHIP Extension Act of 2007
• Section 111 – Provides reporting responsibilities.  Does not replace existing obligations.

MMA – Medicare Modernization Act

MSP – Medicare Secondary Payer
• Medicare does not have primary payment responsibility
• Always a secondary payer to liability insurance

MSPRC – Medicare Secondary Payer Recovery Contractor
• Responsible for recovery of amounts owed to Medicare

ORM – On-going responsibility for medical payments
• RRE’s responsibility to pay, on an ongoing basis, for the injured party’s (Medicare beneficiary’s) medicals associated with a claim

Query
• Process to determine whether an individual is a Medicare beneficiary

RRE – Responsible Reporting Entities
• The company that funds the claim:
o Self insureds
o Insureds with high deductibles:
• Employer until deductible in satisfied, if employer is funding the loss until the deductible is met
• Amount over the deductible:
• Employer continues if they continue to fund the loss
• Insurance company if the loss is funded from the insurance company’s account
o Insurance Company for fully insured plans

SFTP – Secure file transfer protocol

SCHIP – State Children’s Health Insurance program
• Funding which provides health insurance for children within certain income levels

TPOC – Total Payment Obligation to the claimant
• The dollar amount of a settlement, judgment, award, or other payment in addition to/apart from ORM

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Keyword(s) on this page:
| Beneficiary | Coordination of Benefits | Coordination of Benefits Contractor | Garretson | Medicaid | Medicare | Medicare Part A | Medicare Part B | Medicare Part C | Medicare Part D | MMSEA | MSA |