The consolidation of the Coordination of Benefits Contractor (COBC) and Medicare Secondary Payer Recovery Contractor (MSPRC) has caused confusion of attorneys and claims management teams when resolving conditional payments in workers’ compensation and personal injury cases. In order to avoid delay, it is important to take a refresher course in conditional payment matters.
The Benefits Coordination & Recovery Center (BCRC)
The BCRC is now serving as the consolidated contractor for all conditional payment matters. The stated purpose of this consolidation is to provide:
- Improved customer service for stakeholders
- Consolidated and streamlined data collection and recovery operations
- Value added efficiencies and enhanced resource utilization
New Processes for Resolving Conditional Payments
The expected timeline for resolving conditional payments is about eight weeks. As a result, it is important to plan ahead, cooperate with other attorneys and all parties involved in your case, and set realistic expectations. Timely response to all inquiries from the BCRC is essential.
1. Place Medicare on notice through the BCRC. At this time, you will be required to provide them with the following information:
• Beneficiary information (name, date of birth, gender, address, telephone number and Medicare number);
• Injury related information, including the date or injury or ingestion/exposure, description of injury and type of claim (liability, no-fault or workers’ compensation); and
• Representative/attorney information (name of representative/attorney, including law firm if applicable, address, telephone number and Proof of Representation).
2. Rights and Responsibility Letter. This letter outlines the rights and responsibility of the parties and will be issued by the BCRC when they create the case file.
3. Conditional Payment Letter (CPL). This letter will be issued once all claims information has been received and processed. A CPL is NOT a final request amount, but merely what CMS believes is related to the accident or injury. A CPL is issued within 65 days of the Rights and Responsibilities Letter. It is important to review this letter and verify all claims made by CMS are related to the accident or injury regardless of defenses, including reasonableness and necessity.
4. Final Demand Letter. This letter is issued once the case is settled and the representative or parties submit information regarding the settlement. CMS needs to obtain details regarding the information such as the gross settlement:
• Total Amount of Settlement
• Total Amount of Med-Pay or Personal Injury Protection (PIP)
• Attorney Fee Amount Paid by the Beneficiary
• Additional Procurement Expenses Paid by the Beneficiary
• Date the Case Was Settled
Once the Final Demand Letter is issued, parties have a 30-day period to satisfy the debt and avoid interest charging. Information regarding the right to appeal this determination is handled through the BCRC. Failure to perfect this appeal can result in a waiver of your rights.
Tips for Effectively Resolving Conditional Payments
- When putting the BCRC on notice, be sure to include the correct ICD-9/10 codes.
- Coordinate and communicate with your attorney and any service provider involved in the process
- Carefully review the CPL for incorrect/erroneous claims by Medicare
The BCRC can be contacted as follows:
Benefits Coordination & Recovery Center (BCRC) – NGHP
P.O. Box 138832
Oklahoma City, OK 73113
Phone: 1-855-798-2627 OR
Additional information regarding the newly revised conditional payment resolution processes can be found at:
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: firstname.lastname@example.org.
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