Since the Commercial Repayment Center (CRC) became a non-group health plan (NGHP) recovery contractor, inconsistent information from the Medicare Secondary Payer Recovery Portal (MSPRP) has led to questions about the MSPRP reliability which may be improved by the recent release of a revised MSPRP User Guide, version 3.5. The update, released by the Centers for Medicare and Medicaid Services (CMS), improves consistency of the exhibited MSPRP data, showing the CRC case statuses which have been revised to better correspond with the statuses for Benefits Coordination & Recovery Center (BCRC) cases. (Table 13-2) According to the first chapter of the revised guide, several updates are intended to improve functionality.
Authorization to act as recovery agents
- Allows recovery agents who are associated with an insurer-debtor case as the insurer’s Section 111 Mandatory Insurer Reporting (MIR) agent to submit a Recovery Agent Authorization through the portal.
- Permits verified recovery agents to act on behalf of the identified insurer-debtor both pre- and post-demand. (Section 10.3.3)
- Provides MIR recovery agent automatic authority to act on behalf of an insurer-debtor pre-demand. (Section 111)
Ability to edit settlement information that was submitted via the portal
- Permits authorized users to revise settlement information via the portal prior to initiating a demand. The portal will allow users to view settlement information after submission.
- Allows users to add or update settlement information after clicking the “Initiate demand letter” action on the “Case information” page. (Section 13.1.10)
- Permits authorized users to view read-only settlement information after it has been submitted. (Section 13.1.9)
- Renames the action to “Provide the notice of settlement information” on the “Case information” page as “View/provide the notice of settlement information.”
Provide new functionality for conditional payments
- Provides similar BCRC functionality for CRC cases where users may now request an update to the conditional payment amount. (Section 13.1.2)
- Allows beneficiaries and beneficiary representatives who log in using multi-factor authentication to request an electronic conditional payment letter (eCPL), or a mailed copy of the conditional payment letter (CPL). Representatives must have verified proof of representation (POR).
- Allows beneficiaries and beneficiary representatives (with POR) who use multi-factor authentication to request and receive an electronic or mailed version of the “no claims paid by Medicare” letter where the overpayment amount equals $0.00. (Section 13.1.3)
- Permits authorized users to submit unlimited disputes any time prior to the demand, after a conditional payment notice (CPN) or a CPL has been issued. (Section 13.1.5)
- Via notification, informs users that the final conditional payment amount can be selected only once, and that it may be different from the final amount on the confirmation page. (Figure 14-4)
- Removes the word “new” from “Final conditional payment process” section of the “Case information” page. (Figure 13-1)
The improved functionality of the MSPRP will permit recovery agents, insurers, responsible reporting entities (RREs) and third party claims administrators (TPAs) better access to digital records for more efficient claim management. In addition, the portal will allow an unlimited number of pre-demand disputes to be uploaded. Only recovery agents, insurers, RREs or to TPA claim adjustors have authority to request conditional payment correspondence through the mail and only Medicare beneficiaries, their attorneys and others with the written consent of the Medicare beneficiary can request and obtain eCPLs.
Insurers, RREs or recovery agents can only obtain an eCPL with the Medicare beneficiary’s consent, but any debtor insurer/RRE can request conditional payment updates to be sent via U.S. mail. Additionally, RREs and recovery agents will now be able to request updated conditional payment amounts via the portal, mail, telephone or fax.
The revised user guide makes no mention of the reliability of the CRC recovery case information contained in the MSPRP; however, the revisions may be a step toward better consistency.