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CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 6.0) – new updates aimed at enhancing MSPRP functionality

The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 6.0 (January 8, 2024) which includes several updates to MSPRP functionality, including the ability to close cases reported in error and the ability to submit documentation via the MSPRP.[1]

The below provides a general summary of the new MSPRP updates:

Remote Identity Proofing Process (RIDP) update

CMS has implemented a risk-based alternative (RBA) solution provided by Equian to prove MSPRP users’ identities when completing the Remote Identity Proofing (RIDP) process.[2]  Under the RBA solution, MSPRP users can submit personally identifiable information (PII) (full legal name, social security number, date of birth, current residential address, personal email, and personal phone number) through Equian to prove their identity.[3] This process provides authenticated users with the ability to utilize Multi-Factor Authentication (MFA) to view unmasked case information within the MSPRP.[4]

Electronic Data Interchange (EDI) Representative contact information update

As part of this update, CMS has indicated that the e-mail address for contacting an EDI Representative has been updated to COBVA@bcrcgdit.com.[5]  The MSPRP User Guide indicates that COBVA e-mails coming from CMS will show the address as COBVA@mail.cms.hhs.gov.[6] 

Definition of a disputed claim update

In Table 15-13, the definition of a disputed claim has been updated to include reference to situations where a claim was previously disputed during the Final Conditional Payment process and that dispute was denied.[7]

Clarification of case creation for self-reporting non-trauma based claims

The language in Table 13-3, which describes the fields on the “Case Creation Continued” page of the MSPRP, has been updated to clarify that the MSPRP can only accept reports for cases that are related to physical trauma injuries.[8]  The table indicates that cases not involving physical trauma require additional review and must be submitted to Medicare via mail or fax.[9]

Updated ability to close and remove cases reported in error

As part of this update, CMS has added functionality to the MSPRP allowing beneficiaries, insurers, and authorized representatives to close cases which were reported via the MSPRP in error.[10]  The updated language in the MSPRP User Guide indicates that this functionality is only available for cases that were reported via the MSPRP Report A Case process and where a demand has not yet been issued on the case.[11]  The MSPRP User Guide further indicates that a case should only be closed if the case was reported in error as the case will be closed and recovery activities will cease.  The MSPRP User Guide has been updated to include the process for closing a case, which is done through the user’s Case Listing page.[12]

Case documentation submission updates

The final update made by CMS is the addition of functionality allowing MSPRP users to submit documentation via the MSPRP for recovery cases handled by the Benefits Coordination and Recovery Center (BCRC) and the Commercial Repayment Center (CRC).[13] 

The MSPRP User Guide now indicates that the following documentation can be submitted for BCRC and CRC cases that have not been referred to Treasury:

  • Additional Redetermination Documentation
  • Additional Waiver Documentation (BCRC cases only)
  • Exhaust Letter/Insurance Documentation
  • Freedom of Information Act Request
  • Refund Request (CRC cases only)
  • Status Inquiry/Other[14]

These submission options are available to identified debtors and users with valid, verified authorizations.[15]

Questions?

Please do not hesitate to contact the author if you have any questions or would like further information on how Verisk can help you address your conditional payment claims.


[1] As part of this update, CMS includes a “Summary of Version 6.0 Updates” which states, in full, as follows:

The following updates have been made in Version 6.0 of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide:  The Centers for Medicare & Medicaid Services (CMS) has implemented a risk-based alternative (RBA) solution provided by Experian (an external credit service) to prove your identity when completing the Remote Identity Proofing (RIDP) process (Chapter 7). The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS will now show the address as COBVA@mail.cms.hhs.gov (Sections 2.3.6, 4.1.2, 8.3, 19.8). The definition of a disputed claim has been updated (Table 15-13). Language has been clarified on the Case Creation Continued page for self-reporting a case that is non-trauma based (Table 13-3).  To limit the number of cases submitted in error, beneficiaries, insurers, and authorized representatives now have the ability to close and permanently remove a case from their account that was reported via the MSPRP in error (Sections 12.1.3 and 12.2.4). To facilitate easier electronic communication, MSPRP users can now submit correspondence on the MSPRP for BCRC and CRC cases. A Submit Case Documentation action has been added to the Case Information page, along with subsequent pages used to upload and submit documents. In addition, the Letter Activity tab has been renamed Correspondence Activity and references to these screens and sections have been updated throughout the application (Section 15.1.2.13).  Id.

[2] Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 6.0 (January 8, 2024), Chapter 1.

[3] Id, Chapter 7.

[4] Id, Chapter 7.

[5] Id, Chapter 1.

[6] Id, Chapter 1.

[7] Id, Table 15-13.

[8] Id, Table 13-3

[9] Id, Table 13-3

[10] Id, Chapter 1.

[11] Id, Chapter 12.1.3.

[12] Id, Chapter 12.1.3.

[13] Id, Chapter 1.

[14] Id, Chapter 15.1.2.14

[15] Id, Chapter 15.1.2.14


Shawn Johnson, J.D.

Shawn Johnson is legal director, Casualty Solutions at Verisk. You can contact Shawn at Shawn.Johnson@verisk.com.


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