Proven Solutions to Master Medicare's MIR
Mandatory Insurer Reporting (MIR or Section 111) is Medicare’s mechanism to identify “primary payers” when a Medicare beneficiary is involved in a claim. Medicare uses reporting data to seek recovery from primary payers or deny benefits when they believe medical care is not their responsibility. Jorah’s leadership team has developed numerous Section 111 Reporting solutions and has experience integrating with virtually every major insurer and TPA in the market.
Section 111: MSP-Comply Reporting
Jorah offers a complete suite of customizable Section 111 Mandatory Insurer Reporting Solutions to our client partners. MSP-Comply can ingest all major file specifications in a variety of formats and deliver responses that align with our client’s existing claim system requirements. Fully integrated, hybrid and direct entry options are available to ensure seamless compliance regardless of entity size.
Section 111: Data Aggregation
MSP-Comply aggregates data for clients that have multiple TPAs, multiple RREs, or would like to utilize Jorah for management of their Medicare Set-Aside or Conditional Payment programs. Whether you report directly through Jorah or utilize another reporting agent, our system can link our MSA values and Conditional Payment information to your reported claims for compliance and settlement resolution.
Section 111: MIR Audit
Our MIR Audit dives deeply into your MSP reporting and compliance program to identify gaps in the process that are resulting in reporting deficiencies in the query, quarterly reporting, and MSP claims handling. We evaluate your potential exposure and deliver recommendations to resolve and improve your MSP claims handling procedures.
Medicare Set Aside (MSA) Flow
Utilizing proprietary and customizable BI, Jorah leverages Section 111 data to identify claims that need to be evaluated for a Medicare Set-Aside Allocation, automating the identification of exposure. With Section 111 reporting MSA data on all claims involving a Medicare beneficiary, MSA data can be linked to the reported claim to ensure compliance. Clients using MSA Flow* can rest assured that all claims are following their MSP Best Practices.
Conditional Payment (CP) Flow
Pioneered by the leadership of Jorah, our proprietary and customizable BI utilizes Section 111 data to automatically identify claims that have conditional payment exposure. With Medicare’s aggressive recovery efforts through their various contractors, it is critical to proactively identify and resolve conditional payments. Clients utilizing CP Flow* can rest assured that all claims are following their MSP Best Practices.
