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Sedgwick CMS Integrates Medicare Compliance Solution With Claims Management Services

MEMPHIS, Tenn., Oct. 21 /PRNewswire/ -- Sedgwick Claims Management Services, Inc. (Sedgwick CMS) has introduced comprehensive Medicare compliance services as an in-house, integrated program option for its workers' compensation and liability claims management clients. The Sedgwick CMS Medicare solution includes Medicare set-aside determination, Medicare conditional payment ("lien") negotiation and resolution, and related consulting services. The company coordinates all such services with its protocols for fulfilling the Medicare reporting obligations of clients under the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).

The federal government, through its increasingly energetic enforcement of the Medicare Secondary Payer Act (MSPA), has demonstrated its determination to avoid or recover all Medicare costs for which a privately insured or self-insured program can be held responsible. The current implementation of the MMSEA will enable even more rigorous enforcement. The challenge for businesses in meeting their responsibilities under the law is to limit inaccurate or inflated payments without incurring fines or penalties. The Sedgwick CMS strategy for optimizing Medicare compliance provides important advantages in this effort compared to traditional outsourcing models:

  • Medicare compliance is approached as an integral component of the client's claims management program rather than as an unrelated administrative afterthought, aligning Medicare services with overall claims program objectives.
  • Proactive involvement of Sedgwick CMS Medicare specialists earlier in the claims resolution cycle promotes more cost-effective settlement arrangements and more timely and accurate reserving practices.
  • Sedgwick CMS Medicare compliance professionals have access to complete claims records within a secure, integrated information environment, fostering comprehensive understanding of potential Medicare issues and eliminating the privacy exposures of unnecessary data transfers.

"The Sedgwick CMS team of professionals led by Medicare Compliance Director Michael R. Merlino understands what is at stake for our clients in these matters," said Sedgwick CMS President and CEO David A. North. "We are pleased to offer our clients better solutions and greater accountability by addressing Medicare compliance as a core claims management responsibility."

Sedgwick Claims Management Services, Inc. is the leading North American provider of innovative claims and productivity management solutions. Sedgwick CMS and its affiliated companies deliver cost-effective claims administration, medical management, risk consulting and related services to clients through the expertise of approximately 6,400 colleagues in a hundred and fifty offices in the U.S. and Canada. The company specializes in workers' compensation; disability, FMLA and other employee absence; general, automobile and professional liability; Medicare compliance; and warranty and credit card claims services. Sedgwick CMS and its affiliates design and implement customized programs based on proven practices that meet client needs. For more see

Contact: Frank J. Huffman, Senior Vice President, Corporate Communications, 901-415-7548,

SOURCE Sedgwick Claims Management Services, Inc.

SOURCE Sedgwick Claims Management Services, Inc.
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