Managed Care

Since 2005, NovaPro Risk Solutions has been providing Managed Care products and services to it's clients.

MMSEA/Section 111 Mandatory Reporting

As part of our Best Practices, NovaPro Risk Solutions is collecting and maintaining all data elements required by CMS (Center for Medicare/Medicaid Services), based on the most current publication of their User Guide.

NovaPro Risk Solutions is reporting all required data directly to CMS from our proprietary system. It is our belief that the control and security of data is of the utmost importance. This practice requires one less step in the process; doing away with any third-party data manager.

Since our systems are proprietary, we are able to respond quickly to any changes made to the User Guide published by CMS.

NovaPro Risk Solutions is dedicated to:

  • Collecting and maintaining all RRE registration information.
  • Submitting monthly Query to COBC with all active claimant data.
  • Integrating the Healthcare Insurance Claim Number (HICN) returned by COBC into our claim data.
  • Exporting Quarterly Reporting files to CMS in the RRE designated timeframe.
  • Importing the CMS response files and incorporating them into our client files.
  • Providing CMS submission statistics and detail to clients via a Claims Data Port (CDP) feature.
  • Continuing to monitor CMS/Medicare regulations and incorporate changes into our system, as required by CMS.

Medicare Set-Aside (MSA) & Medicare Secondary Payor (MSP)

Since 2005, NovaPro has provided a full range of MSA & MSP services. We also established an internal Mandatory Insurance Reporting (MIR) Team to ensure our staff members are up to date on all the current rules and regulations. Our services include the following:

  • Medical File Review and MSA Evaluation
  • MSA Evaluation and Recommendation of Allocation
  • File Submission to Centers for Medicare and Medicaid
  • Life Care Plans
  • Future Medical Cost Projections
  • Medical Research
  • Lien/Conditional Payment Investigations
  • Free consultation and training for staff regarding compliance to MIR & MSP.

For additional information, contact:

Anna Loy Sayre, CRC, CDMS, CCM, CVE, CLCP, MSCC
P.O. Box 622220    Oviedo, FL 32762
Tel: (407) 249-2957    Fax: (813) 229-9922
Asayre@spectrummanagedcare.com