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' B. The New Information System <br /> * Improved Information Gathering: <br /> In an effort to facilitate the processing of claims consistent with the requirements ofthe MSP stat- <br /> ute, and to assist in meeting the statutory obligations, certain BlueCross and BlueShield Plans <br /> « „ <br /> together with the Health Care Financing Administration ( HCFA ), the federal government <br /> agency which administers Medicare, are developing or have developed a new enrollment and <br /> membership system. The system, also referred to as the"Data Match,"is aimed at obtaining, in <br /> a timely and current fashion, information necessary for the Claim Administrator to identify dual <br /> coverage situations which fall within the MSP statute, and to determine whether primary or sec- <br /> ondary payment should be made for a particular claim. <br /> Under the system,the Claim Administrator will provide basic information to HCFA about individu- <br /> als enrolled in GHPs who are also covered by Medicare so that HCFA can better detect dual cov- <br /> erage situations. <br /> The Employer hereby authorizes and directs the Claim Administratorto disclose to HCFA periodi- <br /> cally,the information identified below pertaining to Medicare-eligible Covered Persons underthe <br /> Plan.The Employer further agrees to cooperate,and to require and facilitate its employees coop- <br /> eration, in supplying to the Claim Administrator the following information. <br /> Information on Medicare-Eligible Covered Persons <br /> •Beneficiary Name <br /> •Date of Birth <br /> •Sex <br /> � •Social Security Number <br /> •Health Insurance Claim Number (e.g., Medicare Number) <br /> •Relationship to Employee (e.g., Employee, spouse of Employee, child of Employee, <br /> other relationship to Employee) <br /> •Reason for Medicare Entitlement (e.g., age, disability or ESRD) <br /> Information on Employee <br /> •Employee Name <br /> •Social Security Number <br /> •Individual Certificate Number of Employee <br /> •Current Employment/Retirement Status <br /> •Coverage Effective Date <br /> •Coverage Termination Date <br /> •Group Plan Number <br /> •Benefits Provided (e.g., Hospital only, medical benefits only) <br /> •Coverage (e.g., individual, family, family but not spouse) <br /> Information on the Employer <br /> •Name and address of employer that pays the bill for coverage <br /> � The Employer agrees that the Claim Administrator's ability to make accurate primary/secondary <br /> MSP determinations depends on the breadth and accuracy ofthe Claim Administrator's files con- <br /> - 13 - <br />