The Centers for Medicare & Medicaid Services (CMS) maintains a web portal called the Medicare Secondary Payer Recovery Portal (MSPRP) used by settling parties or other authorized persons to investigate and confirm the dollar amount of injury related medical expenses paid by Medicare. The Commercial Repayment Center (CRC) is responsible for recovery of mistaken NGHP claims where a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation entity is the identified debtor. Together, the BCRC and CRC comprise all Coordination of Benefits & Recovery (COB&R) activities.
This July, the MSPRP User Guide was updated to improve the functionality of the Medicare Secondary Payer Recovery Portal (MSPRP) in providing a more efficient process for beneficiaries, insurers, and other respective recovery agents to access conditional payment information. Changes to the MSPRP included allowing authorized persons/entities access to view correspondence sent and received on files in chronological order, to request electronic or paper copies of conditional payment correspondence, to confirm primary diagnosis codes on payment summary forms, and to even request a waiver for lien resolution (only after a recovery demand has been issued) and/or file a first level appeal concerning a determination of the conditional payment amounts to be reimbursed to Medicare. In the past, having to rely on phone communication or traditional written correspondence caused delays in obtaining conditional payment amounts in writing.