No-Fault Development

10.8.1 - No-Fault Development (Rev. 39, Issued: 10-21-05; Effective Date: 10-01-05; Implementation Date: 11-19-05) If Medicare is billed as primary payer, but there is an indication of possible coverage under no-fault insurance (including automobile no-fault insurance of all types, including personal injury protection) the contractor shall advise the COBC through the ECRS. The COBC develops to determine whether there is coverage primary to Medicare through a form of no-fault insurance (including automobile no- fault insurance of all types, including personal injury protection). If there is coverage available, the COBC shall post an open "Y" auxiliary record on CWF. Through its initial development with the insurer and/or attorney, the COBC may receive information that indicates that coverage through the no-fault insurance has been exhausted. In these cases, the COBC shall direct the insurer or attorney to forward information to the lead contractor to determine whether benefits have been exhausted. Using the information supplied by the COBC, the contractor processes the claim to payment or denial. If, after the COBC's initial development, the lead contractor later determines that benefits have been exhausted under this policy, it shall post the termination date following the instructions in §10.1. If the lead contractor receives information through recovery development efforts that serves to modify the information that is contained on CWF, it shall send a CWF Assistance Request via ECRS (See§10.2.1). If, upon further investigation the COBC learns that the beneficiary is filing a liability insurance claim, the COBC shall create a new MSP record (with the same effective date as the no-fault) for the liability situation and notify the designated lead contractor to validate that benefits have been exhausted. The lead contractor shall make the determination to terminate the no-fault record. If the lead contractor receives this information, it shall post a termination date (if none is existing), and forward the liability information to the COBC via ECRS (See§10.2.1).