In conjunction with other ongoing efforts to notify Responsible Reporting Entities of updates relative to the PAID Act (Provide Accurate Information Directly), CMS has published an updated Benefits Coordination & Recovery Center (BCRC) 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 5.7, accessible here:

270/271 Health Care Eligibility Benefit Inquiry Companion Guide for Mandatory Reporting NGHP v5.7 August 2021 (cms.gov)

According to the Changes for this Release page:

The following will become effective December 11, 2021: In 2020, the Provide Accurate Information Directly Act (PAID Act) was passed to help NGHP Responsible Reporting Entities (RREs) better coordinate benefits by providing additional beneficiary enrollment information. With this Act, RREs will receive Part C (Medicare Advantage Plan) and Part D (Medicare prescription drug coverage) enrollment information for the past 3 years, as well as the most recent Part A and Part B entitlement dates. To support this Act, the HIPAA Eligibility Wrapper (HEW) software will be updated and the X12 271 query formats will be modified to extract the additional fields (see 271 Eligibility Response Companion Document).

For this release, the Part C Medicare Advantage and Part D Prescription Drug Enrollment Data 271 eligibility response file tables have been updated to display the correct Segment IDs for Element IDs NM101-103. Additionally Part D contract information has been added (Table 26 and Table 27). Other changes have also been made to update and reorganize several tables.

In follow up to a webinar of June 23, 2021, releasing the first details about the new law implementation, CMS is hosting a second webinar to provide additional PAID Act details on September 9, 2021. The alert for the September 9 webinar can be accessed here:

Provide Accurate Information Directly (PAID) Act Testing Webinar Announcement (cms.gov)

The Centers for Medicare and Medicaid Services (CMS) has debuted details relative to the PAID Act (Provide Accurate Information Directly), a new law to be fully implemented by December 11, 2021, with more to come. The Act, signed into law on December 11, 2020, was designed to help Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) better coordinate benefits by providing them with Medicare Beneficiary Part C and Part D enrollment information.

Allan Koba Compliance Solutions continues to monitor advances relative to the PAID Act, and other Medicare Secondary Payer matters. To get more information, please contact us at: info@allankoba.com