Streamlining Medicare Section 111 Reporting for Insurers: Announcing Our Partnership with Verisk

Claims adjusters working in the U.S. know how critical Medicare Section 111 reporting is. And with good reason.

For P&C insurance providers operating in the U.S., it is important to comply with Medicare reporting requirements whenever a bodily injury-related claim is filed regarding a claimant who is eligible for Medicare (typically meaning that they are at least 65 years old). Failure to report Medicare cases can carry hefty penalties. So, although reporting can take up claims adjusters’ valuable work time, insurance companies know it’s a necessary expense – both to protect themselves and to keep their Medicare-eligible customers from missing out on the financial assistance they’re entitled to.

That’s why this week we are so excited to announce our new partnership with Verisk. By streamlining Medicare reporting through automation, our new partnership empowers insurance companies to comply with reporting requirements reliably and efficiently.

At the heart of this partnership is a deep integration between the Five Sigma claims management solution (CMS) and Verisk’s MSP Navigator. This allows for convenient two-way communication between the two platforms, letting our CMS automatically submit reports to Medicare via MSP Navigator and then receive responses.

How does the new integration work?

MSP Navigator is a leading platform for submitting and following up on reports to the Centers for Medicare and Medicaid Services. By enabling our CMS to communicate directly with Navigator automatically, our deep integration simplifies and accelerates the entire process of adhering to reporting requirements – while also helping reduce the risk of error.

Every day, Five Sigma delivers data from insurance carriers to Navigator, and in turn Navigator transfers the information to Medicare. Medicare processes the data, checks for Medicare eligibility, and determines whether any information is missing.

Then, Medicare sends a response to Navigator, stating the status of the claimant and letting Navigator know if any additional data is required. Navigator, in turn, reports back to Five Sigma. This way, our customers can find the details they need right within our CMS, including:

• Whether any eligibility data needed in order to process the claim is missing.
• Whether the claimant is eligible for Medicare.
• Whether the claims adjuster must provide any additional data for eligible exposures.

For example, if a claim has reached an advanced stage and no ICD code has yet been reported, Navigator will send a reminder through Five Sigma for the adjuster to add the missing ICD codes to the claim.

How does the integration make our CMS more useful for claims professionals?

Automation, the innovative use of claims data, and integrations with third-party platforms are already key parts of what makes our cloud-native claims management solution so user-friendly.

Now, by supplementing our intuitive user interface with an automated way to adhere to Medicare reporting requirements, our latest integration uses claims data to help claims departments boost their productivity and avoid the risk of regulatory noncompliance.

Our newest integration follows our recent launch of two APIs for integrating our CMS with policy and payment solutions – APIs that also use communication with third-party platforms to streamline the work of claims adjusters and other insurance professionals. The new integration also follows our partnership with digital payments provider One Inc to let customers send and receive payments directly through our platform. Moreover, our integration with MSP Navigator complements our platform’s built-in, data-driven capabilities, such as just-in-time guidance for claims adjusters and our omnichannel module for both incoming and outgoing communications.

Perhaps most importantly, in partnering with Verisk, we are continuing to make the Five Sigma CMS an increasingly robust, flexible, and user-friendly platform by adapting it to the needs of particular insurance markets. In addition to our newest integration, we also offer other capabilities for addressing region-specific needs, such as the ability to automatically search the United Kingdom’s National SIRA database, its leading database for detecting fraud and other financial crimes.

For more on our partnership with Verisk and our deep integration with MSP Navigator, check out our press release.