Question: How can I query more than 500 claimants and still use Medicare's Direct Data Entry? Answer: You can't.

Unfortunately, the Responsible Reporting Entity or RRE that submitted that question to us does not seem to fully understand the restrictions placed by Medicare on the use of the Direct Data Entry (DDE), or, worse, does not grasp the significance of the privacy agreement they signed with Medicare.   In an effort to provide a low-cost solution to Section 111 Mandatory Insurer Reporting, CMS developed a rudimentary web-based tool that a Responsible Reporting Entity (RRE) can use to meet their MMSEA reporting requirements.

The use of the DDE was specifically restricted by CMS to companies processing less than 500 claims per year.  CMS's policy is not a technical issue to be resolved by an RRE with workarounds; it is a prohibition against large processors using system.  This policy is documented in the NGHP User Guide and associated Alerts.  Keep in mind that the User Guide is much more than your typical "how to" set of instructions.  Section 111 empowers the Secretary of HHS to dictate implementation of the law, and as such, unlike the Medicare Secondary Payer (MSP) Internet Only Manual (IOM), the Courts will probably find the User Guide persuasive.  RREs that flaunt the policies laid out in the User Guide may find themselves facing civil penalties. 

A legitimate RRE won't just run some queries for you, so you can report a Total Payment Obligation to Claimant (TPOC) or Ongoing Responsibility for Medicals (ORM) for query responses that indicate the claimant is enrolled Medicare beneficiary.  Your RRE ID is tied to the DDE.  You are only allowed to report via DDE or via file.  You are not allowed two RRE IDs -- one for queries and one for reporting.  Should a Section 111 Reporting Agent agree to submit queries under an RRE ID that you don't own, that Reporting Agent would be violating the other RRE's Medicare privacy agreement putting both their client  and themselves in a very bad position.

It is not worth the perceived cost savings to try and defeat Medicare's prohibition against adding more than 500 claimants using the DDE.