- On September 3, 2025
Update: MedMutual WELL Webinar Cancelled
Topic: Broker Relations | Companies: Medical Mutual Segment: 51-99, 100+, MEWA
The upcoming MedMutual WELL™ webinars on Sept 9 at 10 a.m. and 3 p.m. are cancelled and will be rescheduled. Medical Mutual apologizes for any inconvenience and will update you with new dates soon.
Reminder: Retro termination and addition guidelines
Topic: Broker Relations | Companies: Medical Mutual, Paramount Segment: Small Group (1-50), 51-99, 100+, MEWA
Reminder of Medical Mutual’s Retro Termination and Addition Guidelines
Medical Mutual’s agreements with our groups require eligibility records be kept up to date. To support better recordkeeping and compliance, the following guidelines apply:
Retroactive Additions
- Additions must be communicated within 60 days of the effective date of the change.
Retroactive Terminations (up to and including 60 days)
- Terminations must be communicated within 31 days of the effective date of the change. Medical Mutual will allow a maximum of 29 additional days for a retroactive termination.
Group Responsibilities
- Eligibility changes must be communicated within 31 days of the effective date.
- Groups are responsible for performing monthly audits of their invoices and maintaining up-to-date eligibility records as outlined in their contracts – doing so ensures smoother operations, fewer claim issues and a better experience for all parties involved.
Accurate and timely updates to membership records are essential for the following reasons:
- Federal and state compliance: We must comply with Rescission rules under 45 CFR 147.128. We must also comply with Ohio law that mandates paid claims must be final after two years.
- Provider agreements: Medical Mutual’s agreement with Cigna prohibits taking back claims from providers if they are over 60 days old.
- Member experience: Inaccurate records can lead to claim denials from subsequent carriers.
- Financial accuracy: Errors in membership records can distort premium rate
development and claim projections. - Contractual obligations: Groups must adhere to their contracts with Medical Mutual regarding eligibility and timely notifications.
If you have questions or a scenario that falls outside of these guidelines, please contact your ExpressLink representative.