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Benefits CoordinationandRecovery Center(BCRC)Overview
Agenda BCRC Responsibilities BCRC Processes– Overview of Data Collection process– Overview of Recovery process Medicare Secondary Payer Recovery Portal (MSPRP) Overview BCRC Contact Information Call Center––IVR TipsVirtual Hold Benefits of BCRC Questions2
BCRC Responsibilities Determining who pays Medicare claims firstEnsuring claims are paid correctlySharing Medicare eligibility data with other primary payersAvoiding duplicate paymentsSending claims data to other insurersRecover conditional payments or mistaken benefit payments3
How it worksBCRCData CollectionRecovery CenterCollects information from multiplesources to research MSP situation.Responsible for identifying andrecovering Medicare conditionaland mistaken payments that shouldhave been paid by another entity asthe primary payer Section 111 Mandatory InsurerReporting and Data SharingAgreements (DSAs) Self Report (phone or portal) Workers Compensation Set-Asides4
Overview of the Data Collection (DC)Process
How Does BCRC Collect Information? Self Report (Call, Fax, Mail)– Attorney, Beneficiary, Insurer, Provider, etc. Data Sharing Agreements (DSA)– DSA – Data Sharing Agreement Mandatory Insurance Reporting (Section 111) Group Health Plan (GHP)Non-Group Health Plan (NGHP) - No-Fault (NF), Workers’ Compensation (WC), andLiability Electronic Correspondence Referral System (ECRS) MSP and Prescription Drug Assistance RequestsMSP and Prescription Drug Inquiries6
Overview of the DC ProcessInsurers, Beneficiaries, Providers orAttorneys report a GHP, NGHP orrequest information on Coordinationof Benefits (COB)BCRC asks probing questions orsends a development letter todetermine if the beneficiary’sMSP record is accurate7
Overview of the DC ProcessOption 1 - Reporting new GHP recordBCRC collects informationby completing an MSPdevelopment questionnaireIn 48 hours systemsare updatedMSP confirmation letter issent to beneficiary8
Overview of the DC ProcessOption 2 - Reporting new NGHP recordBCRC collects informationby completing an MSPdevelopment questionnaireIn 48 hours systemsare updatedMSP confirmation letteris sent to beneficiary9
Overview of the DC ProcessOption 2 - Reporting new NGHP recordSystem forwards all NF and WC leads to theCommercial Repayment Center (CRC)System receiveselectronic informationand creates a LeadSystem forwards all Liability leads to the BCRC10
Overview of the RecoveryProcess11
Recovery ProcessAccident/incident/illness occursBeneficiary goes tohospital/doctorHospital/doctorsubmits claim forpayment12
Recovery ProcessMedicare makesconditional paymentsfor servicesCase is reported toBCRC and informationis gatheredRights andResponsibilities (RAR)Letter is issuedThe payment is “conditional” because it must berepaid to Medicare if/when a settlement, judgment,award or other payment is secured13
Recovery ProcessThe search forMedicareClaims beginsMedical claims related to theincident are identified and aConditional Payment Letter(CPL) is issuedClaims may bedisputed from the CPL ifrecipient feels they are notaccident related14
Recovery Process Settlement, judgment, award, orother payment is reached Notice of Settlement must besubmitted to the BCRCThe final conditional paymentamount is identified and aDemand Letter is sent15
Recovery ProcessOption 1 - PaymentA check is received fordemand amountMSP RecoveryCase Complete16
Recovery ProcessOption 2 – Issues AriseA post demand inquiry is sent.(e.g. questions, appeals,request for waiver, etc.) Appeal – disagreement with theexistence of the full/partialoverpayment amount Waiver – request for the entireoverpayment amount to beforgiven Compromise – request for apartial amount of theoverpayment to be forgiven17
Recovery ProcessOption 3 – Intent To ReferInterest is assessed ifthe debt is notresolved within 60days from date ofdemandIf full repayment is notreceived within 60 daysfrom date of demand, anIntent to Refer Letter (ITR)is issuedIf full repayment is notreceived within 60 days of ITRLetter (120 days of demand),debt is referred to Treasuryonce any outstandingcorrespondence is worked18
Medicare Secondary Payer RecoveryPortal (MSPRP) High level Overview19
Case Access20
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Request Case Access22
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Bene Debtor vs. Insurer DebtorBene DebtorInsurer DebtorCMS is pursuing recovery from thebeneficiaryCMS is pursuing recovery from an insurerCase ID begins with a 2Case ID begins with a 3*BCRC sends correspondence Beneficiary is the primary recipient Authorized parties receive carboncopiesCRC* sends correspondence Insurer is the primary recipient Beneficiary and any authorized partiesreceive carbon copiesBeneficiary and those authorized by thebeneficiary can take action on the caseInsurer and those authorized by theinsurer can take action on the case24
Report a Case25
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Case Information29
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Case Actions36
Contact InformationAreaNumberMedicare Commercial Repayment Center (CRC)BCRC Call Center855-798-2627NGHP – No-Fault & Workers CompTTY Number855-797-2627Data Collection andAuthorizations Fax Line405-869-3308Recovery Documents FaxLine405-869-3309Commercial Repayment Center- NGHPPO Box 269003Oklahoma City OK, 73126NGHP Fax Line- 844-315-7627Workers CompensationSet-Aside (WCSA) Fax Line405-869-3306MSP Data Collection FaxLine405-869-3307EDI Hotline646-458-6740GHPCommercial Repayment Center- GHPPO Box 248909Oklahoma City, OK, 73124GHP Fax Line- 844-315-431337
Contact InformationBCRCMSPData CollectionAreaAddressData Collection AuthorizationData Collections AuthorizationsPO Box 138898Oklahoma City, OK 73113Medicare MSP General CorrespondenceMedicare-MSP General CorrespondencePO Box 138897Oklahoma City, OK 73113Medicare MSP Claims Investigation ProjectMedicare-MSP Claims Investigation ProjectPO Box 138897Oklahoma City, OK 73113Data Sharing AgreementDSA ProgramPO Box 138897Oklahoma City, OK 73113Workers Compensation Set-Aside ArrangementProposalWCMSA Proposal/Final StatementPO Box 138899Oklahoma City, OK 7311338
Contact InformationBCRCAreaAddressNGHP Inquiries/Checks/Recovery AuthorizationsNGHPPO Box 138832Oklahoma City, OK 73113Fixed Percent OptionFixed Percent OptionPO Box 138880Oklahoma City, OK 73113Special Projects (Product Liability Case inquiries and SPChecks)Special ProjectsPO Box 138868Oklahoma City, OK 73116Self Calculated Conditional Payment OptionSelf-Calculated Conditional PaymentPO Box 138880Oklahoma City, OK 73113Recovery39
IVR Tips 855-798-2627 First Menu– Beneficiary- Press 1– Calling about Beneficiary- Press 2– Commercial Repayment Center- Press 4– Selection must be made at this menu beforepressing “0” for an agent40
IVR Tips Beneficiary Menu– 800 Medicare transfer- Press 1– Otherwise Press 2 for BCRC Complete Authentication via speech recognition (4 pieces)– Medicare Beneficiary Identifier (MBI) can be captured here with speech– If Social Security Number is used the, the 4th piece will be Entitlement Date Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on Beneficiary File Unsuccessful Authentication– Call is transferred to an agent41
IVR Tips Other Caller Menu– Provider- Press 1– RRE- Press 2– Attorney- Press 3– Agent, Other Rep- Press 4– Employer- Press 5– DSA- Press 642
IVR Tips Authentication will vary based on caller type– Provider/RRE/DSA 2 pieces to identify entity 2 pieces for Beneficiary– Speech has been added to the Medicare prompt to collect theMedicare Beneficiary Identifier (MBI) Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on BeneficiaryFile43
IVR Tips Authentication (continued)– Attorney/Third Party Administrator (TPA)/OtherRepresentative 4 pieces for Beneficiary– Speech has been added to the Medicare prompt to collectthe MBI– Unsuccessful Authentication– Call is transferred to an agent44
Self Service Information Coverage Status– Medicare Primary Versus Secondary– Status on Specific Date Entitlement Information– Date– Reason ESRD Information– Date of Dialysis– Coordination Period Recovery Information– RAR Date– CPL Mail Date and Amount– Demand Mail Date and Amount45
Virtual Hold Call Center offers Virtual Hold– Offers to call back while holding place in the queue– Once called back, agent is ready to assist– Saves time by not waiting on hold– Enhances customer experience46
How BCRC Benefits our Customers Enhanced Beneficiary experience because claims are processedwith greater efficiency due to accurate records More timely processing of beneficiaries’ medical claims reducesemployers administrative expenses Reduces cost of recouping payments made in error and ensuresintegrity of Medicare Trust Fund47
Questions?48
Recovery Documents Fax Line 405-869-3309 Workers Compensation Set-Aside (WCSA) Fax Line 405-869-3306 MSP Data Collection Fax Line 405-869-3307 EDI Hotline 646-458-6740 Medicare Commercial Repayment Center (CRC) NGHP -No-Fault & Workers Comp Commercial Repayment Center- NGHP PO Box 269003 Oklahoma City OK, 73126 NGHP Fax Line- 844-315-7627 GHP
