MMSEA Compliance


This vital service is provided our TPA clients.  We have cut through the red tape, had meetings with Medicare, employ secure and encrypted software and stay up to date on all NGHP and GHP issues to provide you with the peace of mind you need and deserve.


At TRISTAR, we developed our MMSEA Compliance Services Division to ensure compliance with the Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007.

We assist our TPA clients by ensuring compliance throughout the entire reporting process, from registration, yearly recertification, identification of Medicare Beneficiaries, required reporting and maintenance of compliance records for your protection.

Professional Services
  • Query to identify beneficiaries

  • Claim Reporting

  • Coverage Reporting

  • Liaison with CMS, Coordination of Benefits Contractor, and the Medicare Secondary Payer Recovery

  • Assisting Required Reporting Entities (RRE) with any part of the MMSEA Section 111 Mandatory Insurer Reporting law including:

    • Helping RRE choose the best reporting methodology for their business.

    • Customizing the RRE’s reporting process for efficiency

    • Assisting with required steps RRE’s must take from initial registration

    • Appointment of Authorized Representatives, Account Managers and designees

    • Obtaining Production Status

    • Successfully fulfilling reporting requirements

    • Retention of data documenting RRE’s compliance

    • Identifying beneficiaries, reporting Total Payment Obligation to Claimant, assumption and termination of Ongoing Responsibility for Medicals, for Non-Group Health Plans (NGHP)

    • Identifying beneficiaries covered by Group Health Plans (GHP), and required maintenance for identifying reporting inception of coverage and termination of coverage for beneficiaries

    • Communicating with CMS, the Coordination of Benefits Contractor and the Medicare Secondary

  • Payer Recovery Contractor to protect the RRE’s interests as issues arise. This includes, but is not limited to:

    • Proper registration

    • Changes in RRE information, reporting methods and reporting agents

    • Obtaining conditional payment letters prior to settlement

    • Assisting the RRE obtain approval from CMS on a given injury prior to TPOC settlement

    • All other required or requested services

Partners Claims Services has been an extremely valuable resource for us in attempting to navigate the Medicare Secondary Payor reporting process.


Tricia Martin, Benefits Account Manager

Western States Benefit Planning


     Insurance Agency


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Reporting Methods Utilized
  • Direct Data Entry – This method is best for our clients with fewer than 500 injury claims per year. RREs that qualify greatly reduce expense and risk with this method by avoiding many burdensome reporting requirements and timelines. Reporting fees to query and/or report a required settlement is usually between .5 and 1.0 hours.

  • HTTPS – This method is best for our high volume clients and requires mandatory quarterly reporting during a specified week, successful testing of prescribed data transmission, response file evaluation and correction of specifics identified in the response file.



TRISTAR Risk Management is a proud member of the National Alliance of Medicare Set-Aside Professionals.