CMS Pilots WCMSA Portal

MSAs submitted to CMS for review and approval can slow down the settlement process and at times bring it to a screeching halt if CMS issues a developmental letter requesting additional documentation to perform their review. In addition, obtaining the status of an MSA submitted for review can be a time consuming and frustrating process. As part of their commitment to try to improve efficiencies in the review system, CMS recently announced plans to move forward with the development of the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP). The new portal, currently in pilot testing, is intended to improve efficiencies and WCMSA review turnaround times. As a result, this will hopefully improve the current delays surrounding settlements that seek CMS approval of MSAs.

The CMS Workers’ Compensation Agency Services website states that “This secure web portal will greatly improve the efficiency of the submission process for WCMSAs, including receipt of the proposal by its Workers’ Compensation Review Contractor (WCRC).”

The WCMSAP will allow attorneys, beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors to:

  • Create a work-in-progress case
  • Submit WCMSA cases
  • Perform case lookups
  • Append documentation to a case

The WCMSAP will allow submitters of WCMSAs to directly enter case information, upload documentation, and receive case status information through the use of a secure web portal.

The goal of the pilot is to provide realistic conditions based on live production data, identify potential systems and procedural issues as well as collecting and analyzing feedback to improve the web application which will provide a successful experience for all users.

The WCMSAP will allow tracking of WCMSA cases on a real-time basis via the web portal. Phone calls to obtain case status information will no longer be necessary. Submitters will also be notified electronically if any case documentation is missing or entered incorrectly. Appending new documents and/or replacing documentation will be handled through the web portal. The ability to directly upload case information and obtain real-time status updates should save time and alleviate the need to make several phone calls each day to the WCRC to verify the status of submitted cases.

In order to enter a new case for review on the WCMSAP, the system must verify that the case meets CMS review thresholds and is not a duplicate case. Therefore, basic claim information (name, date of birth, gender, Social Security Number (SSN) or Health Insurance Claim Number (HICN) and date of injury) as well as the proposed total settlement amount will be required to enter the case. The system will not accept the case if CMS review thresholds are not met.
 
This will result in a change to new proposed submissions. Under the current process (not utilizing the WCMSAP), a case will be scanned into the CMS system for review without the proposed total settlement amount. However, this information must be provided prior to the WCRC completing their review or the file will be closed. Since it takes CMS several weeks to scan in the submission and send the information to the WCRC for review, this practice allowed additional time to provide settlement information to CMS if it was not known at the time of submission. With the ability to directly upload documents to the WCMSAP there will be no lag time for scanning and the review process can commence immediately, so adjusters need to be prepared to provide the proposed settlement amount up front.

Once the WCMSAP is fully operational, CMS will still allow manual submission of WCMSA proposals. However, any case that is submitted by mail or by CD-ROM will not be accessible on the WCMSAP.
 
CMS hopes to have the WCMSAP in production by late summer/early fall.

PMSI is pleased to have been invited by CMS to participate in the pilot testing for the WCMSAP and looks forward to bringing you updates on the new system throughout the pilot phase.

Please monitor the CMS Workers’ Compensation Agency Services web site for updated information regarding this initiative. Click here to visit the website.

To sign up for automatic notification of updates from CMS regarding WCMSAs click  here.

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