CMS Updates Medicare Secondary Payer Recovery Portal

By Shawn Deane October 19, 2016

On October 11, 2016, the Centers for Medicare and Medicaid Services (CMS) released a new, updated version of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide.

As many of our readers know, one of the key issues stemming from the transition of a portion of Medicare claims to the Commercial Repayment Center (CRC) has been the inability to successfully gather information from the MSPRP. That said, this month marked a potentially major upgrade in the use and functionality of the portal. We’re hoping that the reliability of the information displayed improves as well. Here are some highlights relative to the updates:

  • Consistency
    • Case statuses displayed for CRC cases have been revised to better match the case statuses displayed for BCRC cases (see Table 13-2).
  • Authorizations
    • Recovery Agents associated with an insurer-debtor case may now submit a Recovery Agent authorization through the portal.
    • A Section 111 Recovery Agent automatically has authorization on an insurer-debtor case before a demand is issued. An entity with an active Recovery Agent authorization that has been verified has the authority to act on behalf of the insurer-debtor both before and after demand (see Section 10.3.3).
  • Settlement Information
    • Authorized users can edit settlement information before initiating a demand, and the portal will allow those users to view settlement information after submission.
    • The authorized user can add or update settlement information after clicking the “Initiate Demand Letter” action and view read-only settlement information after it’s been provided.
    • The “Provide the Notice of Settlement Information” action label on the Case Information page has been renamed to “View/Provide Notice of Settlement Information.”
  • Functionality
    • Users may now request an update to the conditional payment amount (see Section 13.1.2) for CRC cases.
    • Beneficiaries and their representatives with verified Proof of Representation (POR) authorization who log in using multifactor authentication will now be able to request an electronic Conditional Payment Letter (eCPL) or a mailed copy of a CPL. Those users will also receive an electronic or mailed version of a no-claims-paid letter ($0.00).
    • Authorized users may now submit unlimited disputes any time before the case is in a demand status (after a Conditional Payment Letter or Notice has been issued).
  • Notifications
    • A notification has been added to let users know that the final conditional payment amount can be selected only once and that it may be different from the final amount shown on the Confirmation page (see Figure 14-4).
    • The word “New” was removed from the Final Conditional Payment Process section of the Case Information page (See Figure 13-1).

What Does All of This Mean for Insurers and Recovery Agents?

We hope that the updates to MSPRP will greatly affect the functionality as it relates to further integration of CRC recovery claims. Specifically, it will address the following issues:

  • Insurers and their agents may now request CRC conditional payment correspondence to be mailed. This is a huge improvement over the functionality of the portal for workers' compensation and no-fault cases since the CRC transition.
  • Insurers and their agents may now submit an unlimited number of predemand disputes in the portal.
  • Insurers and their agents many now request updated conditional payment amounts through the portal versus phone, fax, or mail.

It’s also important to note that only beneficiaries, their attorneys, and others with the written consent of the beneficiary can request and obtain eCPLs. The eCPL is essentially a downloadable Conditional Payment Letter. The SMART Act mandated that CMS create a methodology for the eCPL and required that all parties have access to this information, provided they have the consent of the Medicare beneficiary. The critical detail here is that the only way any insurer can obtain an eCPL is with the beneficiary’s consent, but any debtor insurer can request conditional payment updates to be sent through the mail.

One of the most anticipated updates, not indicated in the user manual, is an accurate reflection of CRC recovery case information in the MSPRP. As many users of the MSPRP are aware, since the CRC transition, the information in the portal has often been inaccurate. While it’s still too early to tell if this issue has been remedied by the recent updates, we’re monitoring this very carefully and will be providing feedback and working with CMS and the CRC to ensure that the MSPRP is functioning optimally. ISO Claims Partners will provide updates as needed.

If you have any questions about the MSPRP and the recent updates, please contact Shawn Deane, assistant vice president, Product Development, at sdeane@iso.com or (978) 825-8158.


Shawn Deane

Shawn Deane is vice president of product development at ISO Claims Partners where he concentrates on all facets of Medicare Secondary Payer (MSP) compliance. Before joining ISO Claims Partners, he practiced healthcare law and insurance defense. Shawn is a member of the Defense Research Institute, has attained the Medicare Set-Aside Certified Consultant (MSCC) certification, and is the 2017 President of the National Alliance of Medicare Set-Aside Professionals (NAMSAP). He is member of the Massachusetts Bar and is licensed in both state and federal courts in Massachusetts.