What’s Next for the WCRC? New Contract Awarded to Capitol Bridge, LLC

By Sidney Wong September 6, 2017

Since the Workers’ Compensation Review Contractor (WCRC) contract renewal process began in December 2016, the industry has been awaiting news: whether Provider Resources, Inc. (PRI) would be renewed as the WCRC or if CMS would go in a different direction and select a new entity as the contractor. We now have the answer: On September 1, 2017, the Centers for Medicare and Medicaid Services (CMS) announced that the WCRC contract has been awarded to Capitol Bridge, LLC.   

When PRI took over as the Workers’ Compensation Review Contractor in 2012, the industry welcomed the improvements in the Workers’ Compensation Medicare Set-Aside (WCMSA) process—especially improved turnaround times for WCMSA submissions and a more reasonable approach to development letters and re-review considerations.

Key Issues We’ll Be Monitoring

It’s still too early to assess the impact of the change to Capitol Bridge, LLC, from Provider Resources, Inc., but we hope that the new contractor will improve on the process that PRI utilized. Capitol Bridge, LLC is stepping into the WCRC role at a time that the industry is still processing the recent WCMSA changes, such as the introduction of the Amended Review option and important updates released in the recent WCMSA Reference Guide v.2.6. ISO Claims Partners will monitor how Capitol Bridge tackles these issues and others moving forward, including:

  • Will there be any changes to the CMS review process?
  • Will turnaround times be affected?
  • Will there be additional information released this year regarding CMS’ intention to implement a review process for liability and no fault MSAs (LMSA/NFMSA)?

Sidney Wong

Sidney Wong is the assistant vice president of policy at ISO Claims Partners, where he provides the highest level of client services—with a focus on meeting the needs of clients through ISO’s products and services. He is also responsible for assisting clients with effectively navigating Medicare compliance issues.