MMSEA Section 111 Compliance Audit

An MMSEA Section 111 Compliance Audit from ISO Claims Partners is a detailed review of your Section 111 reporting process. Such an audit can help you avoid penalties, improve your workflow, and reduce loss costs.


Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) requires reporting of any settlement, award, judgment, or other payment made to a Medicare beneficiary by any plan of insurance. The law applies to every property/casualty insurer and any company that self-insures risks involving bodily injury (including workers' compensation, general liability, auto liability, professional liability, and others). The act also applies to captive insurers and risk pools.

The purpose of Section 111 is to make sure Medicare has recovered — or can recover — any payments it has made to a Medicare beneficiary when the loss is the primary responsibility of one of those insurance plans. Section 111 imposes significant financial penalties for noncompliance.

The primary objective of an ISO Claims Partners audit is to assess your compliance with Section 111 and to uncover any deficiencies. The process can also identify opportunities to reduce demands on your claims staff, to avoid costs associated with Medicare compliance actions, and to reduce loss costs.

An ISO Claims Partners audit covers the key focal points of your Section 111 reporting process:

  • obtaining query data
  • submitting queries
  • evaluating query responses
  • determining reportable events
  • obtaining required reporting data
  • submitting quarterly reports
  • evaluating quarterly report responses

The audit also reviews:

  • interaction with claims processing systems
  • conditional payment protocol
  • release language

ISO Claims Partners presents its audit findings in a written report highlighting any observed opportunities for improvement in policy, process, or systems.

For more information about ISO Claims Partners Medicare compliance services

Representatives are available Monday through Friday, 9 a.m. through 8:30 p.m. Eastern time.