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HAVE YOU REPORTED YOUR LIABILITY INSURANCE, NO-FAULT INSURANCE, OR WORKERS' COMPENSATION CASE?
The first step in the Medicare Secondary Payer recovery process is reporting your case to the Coordination of Benefits Contractor (COBC). If you have not reported your case, please click here for COBC reporting instructions and contact information.
Don’t Forget!
Once you establish your case with the COBC, you will receive a "Rights and Responsibilities" (RAR) letter from the MSPRC. The MSPRC will then automatically generate a "Conditional Payment Letter" (CPL) within 65 days from the date on your RAR letter. You do NOT need to request the CPL separately.
Coming Soon - The Medicare Secondary Payer Recovery Portal
A new online Self-Service Tool to help manage your Medicare recovery case.
The Centers for Medicare & Medicaid Services (CMS) is in the process of implementing a new web-based tool designed to assist in and accelerate the resolution of Liability Insurance, No-Fault Insurance, and Workers' Compensation Medicare recovery cases. The new tool is called, The Medicare Secondary Payer Recovery Portal (MSPRP).
The MSPRP will give users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will soon be able to be done through the portal.
The MSPRP will allow users the ability to electronically perform the following activities:- Submit Proof of Representation or Consent to Release documentation - Instead of mailing in an authorization, users will be able to upload authorizations through the portal.
- Request conditional payment information - Requesting an updated conditional payment amount or a copy of a current conditional payment letter will be as simple as clicking a few buttons.
- Dispute claims included in a conditional payment letter - Users will be able to view the claims listed on the conditional payment letter and dispute unrelated claims online.
- Submit case settlement information - Users will be able to input settlement information online and upload a copy of the settlement documentation through the portal.
New Option to Self-Calculate Your Conditional Payment Amount
Effective February 21, 2012, the Centers for Medicare & Medicaid Services (CMS) implemented a new option that allows Medicare, in some cases, to provide a final conditional payment amount before settlement. This option involves beneficiaries and/or their representatives self-calculating the final conditional payment amount. If the eligibility criteria are met, this option is best exercised when you have a current conditional payment letter from the MSPRC and you are nearing settlement of the case.
Refer to either the Attorney or Medicare Beneficiary Tool Kit for Self-Calculated Conditional Payment Amount Information (including an example submission package) and Model Language.
New Fixed Percentage Option For Medicare's Recovery Claim
Effective November 7, 2011, the Centers for Medicare & Medicaid Services has implemented a new and simple fixed percentage option that is available to certain beneficiaries. This option is available to beneficiaries who receive certain types of liability insurance (including self-insurance) settlements of $5000 or less.
A full explanation, including instructions on how and when to elect this option, is available in the Fixed Percentage Option section of both the Attorney and Beneficiary Toolkits.Beneficiary Alert: $300 Threshold on Liability Settlements
Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare's criteria are met, the MSPRC will not recover against the beneficiary's settlement, judgment, award or other payment.
We have posted a detailed explanation in the Attorney and Insurer Toolkits.
Alert: Liability Insurance (Including Self-Insurance) and December 5, 1980 (12/5/1980):
Additional policy details have been provided by the Centers for Medicare & Medicaid Services on liability insurance (including self-insurance) cases involving exposure, ingestion, and implantation.Click here to view the update.
Announcements
About MSPRC
The Medicare Secondary Payer Recovery Contractor (MSPRC) protects the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The MSPRC accomplishes these goals under the authority of the Medicare Secondary Payer (MSP) Act. The MSPRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan (GHP) or as part of a Non-Group Health Plan (NGHP) claim which includes, but is not limited to Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. The MSPRC does not pursue supplier, physician, or other provider recovery.
