CMS Pub. 100-06, ch. 6, § 440.7

B3-13450.7

The carrier reports data by total and by source as shown below:

Column (i) Total - All MSP savings regardless of source.

Column (ii) Worker's Compensation, Black Lung, and VA - Data related to all

MSP savings resulting from medical benefits provided by the WC

Plans of the 50 States, the District of Columbia, Guam and Puerto

Rico. Also included is Federal WC provided under the Federal

Employee's Compensation Act, the U. S. Longshoremen's and Harbor

Workers' Compensation Act and its extensions, the Federal Coal Mine

Health and Safety Act of 1969 as amended (the Federal BL Program),

and any fee-for-service medical care paid for by the VA. The carrier

keeps separate records for each distinct category (WC, BL or VA) as

this may become a reporting requirement in the future.

Column (iii) Working Aged - The carrier includes data related to all MSP savings

resulting from benefits payable under an EGHP for beneficiaries aged

65 and older who are covered by reason of their own employment or

the employment of a spouse of any age. Medicare Claims

Processing, Chapter 28, Coordinating With Medicaid and Medigap

Insurers further defines the individuals subject to this limitation on

payment.

Column (iv) ESRD - The carrier includes data related to all MSP savings resulting

from benefits payable under an EGHP for individuals who are entitled

to Medicare benefits solely on the basis of ESRD during a period of

up to 12 months. The period during which Medicare pays benefits is

defined in Medicare Claims Processing, Chapter 28, Coordinating

With Medicaid and Medigap Insurers.

Column (v) Auto Medical, No Fault and Liability Insurance - The carrier

includes data related to all MSP savings resulting from both:

Automobile Medical or No Fault Insurance - Insurance coverage

(including a self-insured plan) that pays for all, or part, of the medical

expenses for injuries sustained in the use of, or occupancy of, an

automobile, regardless of who may have been responsible for the

accident. (This insurance is sometimes called "personal injury

protection," "medical payments coverage" or "medical expense

coverage.")

Liability Insurance - Insurance (including a self-insured plan) that

provides payment based on legal liability for injury, illness, or damage

to property. It includes, but is not limited to, automobile liability

insurance, uninsured motorist insurance, homeowners' liability

insurance, malpractice insurance, product liability insurance, and

general casualty insurance. It does not include situations where a

beneficiary receives medical payment under his or her own

homeowner's insurance.

Column (vi) Disabled - The carrier includes data related to all MSP savings

resulting from situations where Medicare is the secondary payer for

disabled beneficiaries under age 65 (except ESRD beneficiaries) who

elect to be covered by a large group health plan (LGHP) as a current

employee or family member of such employee. A LGHP is any health

plan that covers employees of at least one employer who normally

employs 100 or more employees. The disabled provisions apply to

items and services furnished on or after January l, 1987 and before

January l, 1992.