CMS Enters into Data Exchanges with State Agencies Including California

 t a recent meeting in Atlanta GA, CMS (Centers for Medicare and Medicaid Service) announced State Workers’ Compensation Data Exchanges.

 
Armed with the regulatory authority of: 42 CFR 411.24-26, 42 CFR 411.45 and 42 USC 1395y(b)(2) CMS has entered into Data Sharing Agreements with California. Preliminary discussions have been held with: Oregon, Texas, Kansas, Nebraska, New York, Maryland, Florida and Kansas. Several States have indicated interest in data sharing including: Pennsylvania, Oklahoma, Georgia, North and South Carolina, Virginia and Mississippi; and a number of States including Washington, Idaho and New Jersey were reported as not interested or not responding.
 
California reportedly exchanged its first monthly submission that amounted to 73,608 records and of those 22,180 (30%) were rejected and 1,762 (3%) were matched. Additionally 1,756 new records were identified.
 
Records rejection included:
-Non-active status = 8,648
-Invalid SSN = 1,660
-Missing Insurer = 5,551
-Invalid Injury Date = 6,076
-Invalid DOB = 296
-Worker Deceased = 278
 
CMS has established 3 options for data matching with State agencies. The process identifies 46 fields from the claimant’s social security number through the settlement amount.
 
Data exchange is vital for CMS as it attempts to enforce and verify notice requirements as reflected in 42 CFR 411.25. The regulation imposes requirements to report upon: a third party payer; employer; insurer; underwriter or third party administrator.