Thursday, February 25, 2010

Query Access System - Is Plaintiff Authorization Required

I understand that the defendant’s obligation to report is not until after the case settles (and only if it settles). Defendants are allowed (but not required) prior to settlement to access Medicare's Query Access system to find out if the claimant is Medicare eligible. Assuming they need to report at some point in time, the bottom line question is, does the insurance company (defendant) need an authorization signed by my client in order to access the Medicare Query Access System? Several companies are claiming they must have the authorizations signed by our clients before they can get the information from Medicare.

-Ohio Attorney

The defendant (RRE) does not need a release to obtain the five data points to perform the query function to obtain entitlement information. CMS has stated that their response to the RRE will only tell the RRE entitlement status. It will not provide the RRE with why the injured party is entitled, when the injured party became entitled or the SSDI status. The response will only tell the RRE whether there was a match and that the injured party is entitled or that there was no match.

We have seen many RREs requesting that a release be signed. This is absolutely not necessary for the query function or for the submission process.

My best,
Matt Garretson