2017 Property and Casualty Medicare Secondary Payer Mandatory Reporting Requirement

For No-Fault and Workers’ Compensation claims, the TPOC threshold is now $750 when TPOC Dates are 10/1/2016 and subsequent.  For Liability claims, the TPOC threshold is now $750 when TPOC Dates are 1/1/2017 and subsequent.

On Friday, January 6, 2017, the Centers for Medicare and Medicaid Services (CMS) published an updated Section 111 User Guide. The minimal changes in version 5.2 involve inclusion of the recent Alert modifying the Total Payment Obligation to the Claimant (TPOC) amounts and CJ07 error.

The CJ07 error code will be returned on claims where the Ongoing Responsibility for Medicals (ORM) Indicator is set to “N” and the cumulative TPOC amount is zero. The full User Guide can be downloaded here.