Workers’ Compensation Data Fields 14 The “Medicare” tab is located within the injured worker party screen. Medicare will make a “Conditional Payment” when timely payment by a primary payer, such as a TPA, is not expected. Medicare (CMS) will expect to be reimbursed. This is known as a “Medicare Lien.” Medicare Set Aside There are two classes of beneficiaries where we need to recognize Medicare’s interests: • Class I: Over 65 years of age, on Social Security Disability Insurance (SSDI) for 24 months or longer, or suffering from end stage renal disease • Class II: On SSDI and not Medicare eligible, applied for or denied SSDIB, 62 ½ years of age, permanent total disability claim, no return to work in 12 months or longer, or a “reasonable expectation” of Medicare enrollment within 30 months of settlement date. A “reasonable expectation” would include claims where the indemnity reserve is more than $100,000 or if the injured worker is an SSDI applicant and meets the above criteria. NOTE: When injured worker contact is initially made, inquiry should be made as to whether they are a Medicare beneficiary. • Center for Medicare and Medicaid Services (CMS) will not review settlement of a Class I beneficiary if the value of the settlement is less than $25,000 Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.