It is difficult for payers to identify if primary or secondary payment should be paid on a working aged individual because the employer group size is unknown. If the size of the group health plan is not known or is incorrect, then the claim could be paid incorrectly according to Medicare regulations. Incorrect claims payments could result in the payer receiving fines and penalties from the Centers for Medicare and Medicaid (CMS).
Often payers do not have the resources or processes to effectively gather and maintain group size information required by CMS. Accent’s customized outreach programs gathers employee count information from groups and reports the information back to payers. Employers are able to respond conveniently via multiple response mechanisms. Additionally, Accent’s experienced staff, acting in either first or third party, is available to guide the employer through the response process.
Automating the Employer Group Size Verification workflow minimizes both labor and operational expenses while ensuring the payer is in compliance with their customers' and CMS's policies and procedures.
