Medicare Secondary Payer Recovery - General Information

What's New

March 28, 2013

The Centers for Medicare & Medicaid Services (CMS) is restructuring its coordination of benefits (COB) and Medicare Secondary Payer recovery activities.

This action will provide:

• Improved customer service for stakeholders
• Consolidated and streamlined data collection and recovery operations
• Value-added efficiencies and enhanced resource utilization

First CMS will transition all Group Health Plan (GHP) recovery activity to the Commercial Repayment Center (CRC). The CRC will assume responsibility for GHP case work on May 13, 2013.  The Medicare Secondary Payer Recovery Contractor will continue to perform liability insurance (including self-insurance), no-fault insurance, and workers’ compensation (Non-Group Health Plan) recovery case work.  At a later date, CMS will transition all COB and Non-Group Health Plan recovery activities to a Business Process Operations Center. 

Visit this web site regularly for updated information related to the transition activities.  

The Centers for Medicare & Medicaid Services (CMS) has consolidated all of the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries into one MSP recovery contract.   The contract for the new national MSP Recovery Contractor (MSPRC) was implemented on October 2, 2006.

The MSPRC has taken over new MSP recovery claims and most existing claims.  However, some existing MSP recovery claims will remain the responsibility of the claims processing contractors.  The following sections will help you determine how the change to a national MSPRC will affect you. 

What does implementation of the MSPRC mean for you if you are a provider physician, or other supplier?

The recovery of provider, physician or other supplier MSP recovery claims will continue to be the responsibility of the contractor which processed the underlying Medicare claim.  Consequently, providers, physicians, and other suppliers should not see any changes in CMS' processes for recovering debts where the provider, physician, or other supplier is overpaid due to receiving a duplicate payment from both an insurer or workers' compensation carrier and Medicare.

What does implementation of the MSPRC mean for you if you are: (a) an employer, insurer, GHP, third party administrator, or other plan sponsor subject to the MSP GHP provisions of the Social Security Act; (b) a workers' compensation plan or a liability or no-fault insurer; (c) a beneficiary (or the representative of a beneficiary)?

For all new MSP initial recovery demand letters issued on or after the implementation date for the MSPRC (October 2, 2006), you should respond to the entity which issues the recovery demand letter to you.  Except for provider, physician, or other supplier MSP recovery claims and a limited number of GHP debts in certain states, this will routinely be the MSPRC.  (Please note that a letter providing the amount of Medicare's conditional payments in connection with a workers' compensation or liability or no-fault insurance case is not a recovery demand letter.)