It was announced on October 5, 2017, that the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation (Performant) the Commercial Repayment Center (CRC) contract. Two years ago, the CRC was expanded to include Non-Group Health Plan (NGHP) conditional payment recoveries in which the insurer or self-insured is the identified debtor. This was a major change to the industry since the CRC seeks recovery as soon as responsibility is demonstrated–as evidenced primarily through Section 111 reporting–and on a continual basis, so long as the primary payer remains responsible. The contract was previously held by CGI Federal, which also held the Group Health Plan (GHP CRC) recovery contract.
Performant announced it had been award the CMS contract and detailed its involvement stating:
Under the program, Performant is responsible for identifying and recovering payments in situations where Medicare should not be the primary payer of healthcare claims because a beneficiary has other forms of insurance coverage, such as through an employer Group Health Plan or certain other payers. At full scale, Performant anticipates staffing the program with over 250 dedicated employees operating out of Performant’s offices around the country.
Performant may be familiar to some in the Medicare Secondary Payer (MSP) space, as the company acts as a Private Collection Agent (PCA) for the U.S. Department of the Treasury. Overdue federal debts, including conditional payment demands, can be referred to a PCA for collection. Performant is also a Recovery Audit Contractor for Regions 1 and 5. Performant’s multiple roles in MSP recovery will make for an interesting dynamic.
This is the second recent MSP contractor switch, as the agency announced a new Workers’ Compensation Review Contractor (WCRC). With both of these new contractors, there are likely to be many changes coming in 2018.
ISO Claims Partners has worked through a number of contractor transitions, and we will be here to guide our valued customers through the changes and challenges ahead.