A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) can be submitted electronically through the WCMSA Portal (WCMSAP), or sent by mail, either as paper documents or CD. Using the WCMSAP for your WCMSA submission is the recommended approach as it is more efficient than mailing this information. For information about how to use the WCMSAP, please see the WCMSAP page. If you are submitting the proposal on paper or CD, please send your information to the WCMSA address on the Contacts page.
WCMSAs are handled in the order they are received regardless of the submission method used. Once a WCMSA is submitted, it will be recorded in a national, centralized database, and electronically forwarded to the CMS Workers’ Compensation Review Contractor (WCRC).
For detailed information on the WCMSA submission process, please see the WCMSA Reference Guide which is available in the Downloads section of the WCMSA page.
WCMSAP submitters receive immediate confirmation of successful submission on the portal. Additionally, WCMSAP submitters and paper/CD submitters receive an acknowledgement letter. If you do not receive an acknowledgement letter, please contact the Benefits Coordination & Recovery Center (BCRC). See the Contacts page for BCRC phone numbers.
Review and Decision Process
After a WCMSA proposal is submitted, the WCRC performs an independent review of the proposed medical and prescription drug costs. Evaluation tools are used to determine if the proposed WCMSA amount is adequate to protect Medicare’s interests. During its review, the WCRC may send development letters (paper/CD submitters) or e-mail alerts (WCMSAP submitters) to obtain missing or incomplete information related to the case. When the WCRC completes its review and renders their recommendation, the recommended value and rationale is sent to the Regional Office (RO) assigned to the case.
Regional Office Determination
When the RO receives the case, they review the submission package and the WCRC recommendation. The RO makes a determination as to the final WCMSA amount and notifies the submitter of their decision, by letter for paper/CD submissions, or e-mail alert, for WCMSAP submissions. The submitter may receive any of the following notifications:
- Approval letter if the RO agrees with the proposed WCMSA;
- Denial letter explaining the reason for the denial; or
- Closeout letter explaining why the WCMSA was closed.
Should the need arise to contact the CMS Regional Office that is assigned to your case, refer to the CMS Regional Office contact list https://cms.gov/RegionalOffices/
Request for Re-Review
If the submitter believes the recommended value is the result of an error, they may be eligible to submit a re-review request. For information on re-review requests, please see the WCMSA Reference Guide which is available in the Downloads section at the bottom of the WCMSA page.
If the case qualifies, the re-review request should be submitted as follows:
- For a proposal that was submitted electronically (via the WCMSAP), please use the WCMSAP application. See Chapter 12: Manage Existing Case in the WCMSAP User Manual for more information on this topic. This User Manual is available on the Reference Tab of the WCMSAP application.
- For a proposal that was originally submitted on paper or CD, please submit your request in writing to the WCMSA address on the Contacts page.