Minimizing Risks of Medicare Secondary Payer Claims: Update on the PAID Act

By Barrye Miyagi, Partner

Most litigators are aware of the importance of determining if Medicare and certain private insurers known as Medicare Advantage Plans have an interest in their case. In sum, these entities may have a right of reimbursement under the Medicare Secondary Payer Act (the MSP). Identifying these insurers is often a challenge. The PAID Act was designed to address that issue. We blogged on the PAID Act on June 26, 2018.

Last week, the Centers for Medicare & Medicaid Services (CMS) discussed implementation of the PAID Act in a Town Hall meeting. CMS provided the following information in its Town Hall:

Currently, Medicare provides Responsible Reporting Entities (RREs) with information on a claimant’s Medicare-eligibility through a query process in the Section 111 Reporting Portal. The query response does not currently identify a claimant’s Medicare Part C and Medicare Part D providers. Identifying Part C and Part D providers assists all interested parties in properly coordinating benefits. CMS is implementing a plan to provide RREs with Part C and Part D information.


  • October 4, 2021: RREs who use the Direct Data Entry (DDE) option for Section 111 reporting will have access to Part C and D information.
  • December 11, 2021: RREs who Section 111 report electronically will have access to Part C and Part D information.

Required Action

  • Updated HIPAA Eligibility Wrapper (HEW) software is required to run the query and obtain a response file. The query response file will not be available without this update.

Technical Guidance

  • CMS Paid Act Alert
  • Appendix K of the CMS NGHP User Guide
  • Version 5.5 of the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide (

Important Dates

  • September 9, 2021: CMS will offer a testing webinar.
  • September 13, 2021 through December 10, 2021: RRE testing period. Testing is encouraged but not required.


  • Identity of Part C and Part D providers is limited to 3 years before the query.
  • Only up to 12 occurrences of each Part C and Part D plan data will be provided.

Does Implementation of the PAID Act Affect my Practice?

As mentioned in our prior article, the PAID Act benefits several interests. For advice on how implementation of the PAID Act may affect your business or for best practices for compliance with the MSP, please contact Taylor Porter Partner and Medicare Secondary Payer and MMSEA (Section 111) Compliance practice group leader Barrye Miyagi.

About Barrye Miyagi: Taylor Porter Partner Barrye Panepinto Miyagi is a Certified Medicare Secondary Payer Fellow (CMSP-F), administered by the Louisiana Association of Self Insured Employers (LASIE), and she is the practice group leader of Taylor Porter’s Medicare Secondary Payer and MMSEA (Section 111) Compliance group, which handles issues related to the Medicare Secondary Payer Act. Barrye counsels businesses on the Medicare rules and regulations, including identifying and resolving Medicare’s interest in settlements and judgments, as well as complying with Section 111 of the Medicare, Medicaid and SCHIP Extension Act.

Please note this information is accurate as of the date of the published article on June 29, 2021.