Medicare Secondary Payer: IRS-SSA-CMS Data Match

Medicare Secondary Payer: IRS-SSA-CMS Data Match

Employers should respond within 30 days of CMS’ inquiry, unless an extension has been requested and approved. Failing to respond may trigger penalties.

The Omnibus Budget Reconciliation Act of 1989 requires the Internal Revenue Service (IRS), Social Security Administration (SSA), and Centers for Medicare & Medicaid Services (CMS) to share information about whether Medicare beneficiaries or their spouses are working. The process for sharing this information is called the IRS-SSA-CMS Data Match (Data Match). The purpose of the Data Match is to identify situations where another payer, such as an employer-sponsored group health plan, has the responsibility for paying before Medicare.

Employers may receive letters from CMS asking if certain individuals worked during a specific time period, and if so, whether they had employer-sponsored group health plan coverage. These inquiries, which are part of the Data Match program, help Medicare identify claims on an ongoing basis for which Medicare should not be the primary payer.

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