JDi Data Claims Manager® Integrated API for MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting

Scroll to:

By H. Eddie Hu, JDi Data, Senior Software Engineer

With its intuitive user interface and sophisticated system design, the JDi Data Claims Manager® provides users an easy way to manage their claims data, retrieve their claims data fast and secure from anywhere with Internet access.
If you are a claim adjuster or manager in the insurance industry, you know that managing the claim is only part of the work. There is plenty of compliance reporting that follow. One being the MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting.
There are several ways to achieve this mandatory reporting.
CMS provides the Direct Data Entry (DDE) service through the Section 111 COB Secure Website (COBSW). Once you register and sign up with the service you can enter the data via the secure web service.  This option becomes a very heavy manual operation.  Alternatively CMS also provides Electronic Data Interchange (EDI) service for this compliance reporting. The data is submitted in specific file format, in response, the result file will also be in a designated file format. Nevertheless to say, it can be very technical inclined.
Third party agents have another solution for the mandatory reporting. With lots of choices for adjusters to pick JDi Data Claims Manager ® takes it to the next level and fully supports our clients in this process. Gould & Lamb has been the main compliance agent of choice. Gould & Lamb is the Industry Leader and Provider of Medicare Compliance Services to the Global Insurance and Self-Insurance Marketplace.
In order to support our clients to this Medicare compliance reporting and provide flexibility for them to pick a third party agent, we designed and implemented the Claims Manager® integrated API for MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting. Currently this API can directly interact with CMS Section 111 COB secure server to submit claim data and retrieve response file from CMS, process the response file in the Claims Manager® system for the adjusters or mangers to review and correct errors when necessary. The API also interacts with Gould & Lamb’s secure server for submitting claim data and process the result back into the Claims Manager® system.
In principle, this Claims Manager® API will simplify this compliance reporting for users by taking the repetition and manual work out of adjusters, automatically submit claim data to CMS or your designated agent, and process the result for you to review in the Claims Manager® system.
As the claim adjuster you enter the claim and claimant information in the Claims Manager® system once and forever. The API is programmed to retrieve the required data from around the Claims Manager® system, format the data in the specific file format, and submit the file to CMS or your agent. When the result file is ready from CMS or your agent, the API will pick it up from the designated secure server and process it neatly in the Claims Manager® system, and create an error report for you to follow up when necessary.