United Benefit Advisors Insight and Analysis Blog

CMS Requires Prescription Drug Coverage Reporting under Section 111 MSP Reporting

By Karen Hsu, Director of Compliance at United Benefit Advisors
  Oct 3, 2019 9:18:00 AM

The Centers for Medicare and Medicaid Services (CMS) revised its Section 111 Medicare Secondary Payer (MSP) User Guide and issued FAQs that require responsible reporting entities (RREs) to submit primary prescription drug coverage information as part of their Section 111 MSP Mandatory reporting requirements effective January 1, 2020.

UBA-1000_Section111_MSP_Coverage

The RRE for reporting primary prescription drug coverage is the entity that has direct responsibility for processing and paying prescription drug claims. In most cases, the RRE will be the insurer or TPA. For example, if the plan sponsor contracts with a third party such as a pharmacy benefits manager (PBM) to administer prescription drug coverage, then the PBM is considered the RRE for prescription drug reporting purposes. However, for self-funded plans that are self-administered, the RRE will usually be the plan administrator.

Topics: prescription drug coverage, compliance recap