Highlights of June 23rd CMS Webinar Covering PAID Act Changes


CMS hosted a webinar on June 23, 2021 discussing various issues regarding the Provide Accurate Information Directly (PAID) Act. The purpose of the PAID Act is to provide primary payers with information concerning Part C (Medicare Advantage) and Part D (Prescription Drug) plans so primary payers are able to identify and resolve any claims that may be asserted by such plans. To implement the requirements of the PAID Act, CMS will be making several changes throughout the remainder of 2021. Below are the highlights of the CMS webinar and those changes.


New NGHP Response File Fields

Several new fields are being added to the NGHP CMS Response File. Those are as follows:


Fields 12-13: Most recent Part A effective and termination date

Fields 14-15: Most recent Part B effective and termination date

Fields 16-135: Part C data including:

Plan Contract Number

Enrollment Date

Termination Date

Plan Contract Name

Plan Benefit Package Number

Plan Contact Address

Plan Contact City

Plan Contact State

Plan Contact Zip Code

Fields 136-255: Part D data including:

Plan Contract Number

Enrollment Date

Termination Date

Plan Contract Name

Plan Benefit Package Number

Plan Contact Address

Plan Contact City

Plan Contact State

Plan Contact Zip Code


Information That Will be Provided by CMS Concerning Part C and Part D Plans

CMS will be providing up to 12 instances of each Part C and Part D Plan in which a beneficiary was enrolled during the preceding three years, beginning with the date of the query. CMS noted that the three-year timeframe was established by Congress in the text of the PAID Act and was not established independently by CMS. If a beneficiary is enrolled in both a Part C and Part D plan, information concerning each will be returned in the Part C and Part D data fields.


DDE Users

RREs who use the Direct Data Entry method of reporting will also be able to obtain the same Part C and Part D information during the query and reporting process. The 500 query limit will still apply.


Beneficiary Lookup

Beginning October 4, 2021, information concerning Part C and Part D plans for beneficiaries will be available through the COBSW Beneficiary Lookup option.


HEW Software Changes

Updated HEW software which incorporates the new changes will be made available to RREs. The updated software may be downloaded on September 13, 2021. Both the Windows and mainframe versions of the HEW application will be modified to accept the new information in an NGHP 271 X12 file and convert it to a fixed-length Section 111 Query Response flat file. RREs will be able to test the new functions without disrupting their regular reporting process.


Software Testing Period

From September 13th through December 10th, CMS will conduct testing related to Part C and Part D plan information. More details concerning the testing will be released at a later date.


Where to Submit Part C and Part D Questions

CMS provided the following email addresses to which questions concerning Part C and Part D may be submitted:

Part C Mailbox: https://dpapportal.lmi.org/DPAPMailbox/

Part D Mailbox: PartD_COB@cms.hhs.gov


Additional Important Clarifications

During the Question and Answer portion of the webinar, CMS provided the following information:

  • CMS will not be handling recovery efforts on behalf of Part C and Part D plans. Claim and recovery efforts will continue to be handled independently by those plans.

  • CMS currently reports information to Part C and Part D plans regarding the identity of RREs who submit claim files and will continue to do so. Only the identity of the RRE is reported to those plans, not specific ORM, TPOC or other claim information. The RRE’s identity only is transmitted to the Part C or Part D plans upon submission of claim information, not in response to queries. It is the responsibility of the RRE to contact those Part C and Part D providers to request information about claims the Part C and Part D plan may have that would fall under the primary payer’s responsibility.

We will continue to be actively involved in the changes announced by CMS as they work to comply with the PAID Act. If you have questions at any time or need assistance with Part C or Part D plan research or resolution, please let us know. We’ll be happy to help.

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