Voluntary Data Sharing Agreement (Non MSP Reporting Only)Voluntary Data Sharing Agreement • July 19th, 2024
The collection of this information is authorized by Section 1862(b) of the Social Security Act (codified at 42 U.S.C 1395y(b)) (see also 42, C.F.R. 411.24). The information collected will be used to identify and recover past conditional and mistaken Medicare primary payments and to prevent Medicare from making mistaken payments in the future for those Medicare Secondary Payer situations that continue to exist. The Privacy Act (5 U.S.C. 552a(b)), as amended, prohibits the disclosure of information maintained by the Centers for Medicare & Medicaid Services (CMS) in a system of records to third parties, unless the beneficiary provides a written request or explicit written consent/authorization for a party to receive such information. Where the beneficiary provides written consent/proof of representation, CMS will permit authorized parties to access requisite information.
VOLUNTARY DATA SHARING AGREEMENT (VDSA) For Reporting Non-MSP DataVoluntary Data Sharing Agreement • July 31st, 2024
This Voluntary Data Sharing Agreement (the “Agreement”) for the exchange of health care coverage enrollment information is entered into between [insert Reporter name] and related entities as identified herein, a [insert State name] Legal Entity, with its principal address at [insert User address] (the “Reporter”) and the United States Department of Health and Human Services, acting by and through the Centers for Medicare & Medicaid Services (“CMS”) (together, the “Parties”) on this day of , 20 (the “Effective Date”).
EMPLOYER VOLUNTARY DATA SHARING AGREEMENT (VDSA)Voluntary Data Sharing Agreement • May 5th, 2020
This Voluntary Data Sharing Agreement (the "Agreement") for the exchange of health care coverage enrollment information is entered into between [insert Employer name] and related entities as identified herein, a [insert State name if appropriate] Corporation, with its principal address at [insert Employer address] (the "Employer") and the United States Department of Health and Human Services, acting by and through the Centers for Medicare & Medicaid Services ("CMS") (together, the "Parties") on this _ day of
Voluntary Data Sharing AgreementVoluntary Data Sharing Agreement • May 5th, 2020
This version of the VDSA User Guide is for the exclusive use of reporting entities that will be using the “D – Non-MSP Only Input File” to do reporting of prescription drug coverage that is secondary to Medicare prescription drug coverage.
Voluntary Data Sharing AgreementVoluntary Data Sharing Agreement • February 19th, 2008
The document that follows replaces the previous edition of the VDSA User Guide, dated January 10, 2008, as well as all earlier and interim later versions. We continue to edit all text in the User Guide for accuracy and clarity.
INSURER VOLUNTARY DATA SHARING AGREEMENTVoluntary Data Sharing Agreement • April 23rd, 2008
This Voluntary Data Sharing Agreement (the "Agreement") for the exchange of health care coverage enrollment information is entered into between [insert Insurer name] and related entities as identified herein, a [insert State name if appropriate] Corporation, with its principal address at [insert Insurer address] (the "Insurer") and the United States Department of Health and Human Services, acting by and through the Centers for Medicare & Medicaid Services ("CMS") (together, the "Parties") on this day of , 20 (the "Effective Date").
Voluntary Data Sharing AgreementVoluntary Data Sharing Agreement • May 5th, 2020
The document that follows replaces the previous edition of the VDSA User Guide, as well as all earlier and interim versions. We continue to edit all text in the User Guide for accuracy and clarity.
