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 sending this information via the mail.
If you are submitting your proposal electronically, please use the WCMSAP Application which is found in the Related Links section near the bottom of the page. For information about how to use the WCMSAP, please see the WCMSAP page.
For information on the WCMSA submission process, please see the WCMSA Reference Guide which is available in the Downloads section at the bottom of the page. Should the need arise to contact the CMS Regional Office that is assigned to your case, refer to the RO Contacts document found in the Downloads section for a list of telephone numbers. If you are submitting the proposal on paper or CD, please send your information to the following address:WCMSA Proposal/Final Settlement P.O. Box 138899 Oklahoma City, OK. 73113-8899
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).
Once you have submitted a WCMSA proposal, you will receive an acknowledgement letter, for paper/CD submissions, or e-mail alert, for WCMSAP submissions. If you do not receive an acknowledgement letter or e-mail alert, please contact the Benefits Coordination & Recovery Center (BCRC). BCRC Customer Service Representatives are available to assist you Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays, at toll-free lines: 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).
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 submitters) or e-mail alerts to the submitter to obtain missing or incomplete information related to the case. When the WCRC completes its review and renders their recommendation, the WCMSA is sent to the Regional Office (RO) assigned to the case.
Regional Office Determination
When the RO receives the case, they review the WCMSA 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.
Request for Re-Review
If the submitter disagrees with the RO decision, they can submit a re-review request. For information on the re-review request, please see the WCMSA Reference Guide which is available in the Downloads section at the bottom of the 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 portal application found in the Related Links section below. Please see Chapter 12: Manage Existing Case in the WCMSAP User Manual for more information on this topic. This Use 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 following address:
- Page last Modified: 02/28/2018 3:47 PM
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