Verified

Authorization has been reviewed and approved.

Unverified

Authorization is currently under review.

Invalid

Authorization has been reviewed and rejected.

Note: When an authorization is submitted, you are required to upload supporting documentation that backs up the authorization you are requesting. For a complete description of all authorization document types and what is required in your uploaded documents, view the requirements found at the following link: Supporting Documentation Requirements.

Reasons Authorization is Rejected

The main reason that an authorization would be rejected is if there is a problem or error with the supporting documentation. When an authorization is rejected, the reason for the rejection will display next to the Invalid status. Any authorization that is rejected must be resubmitted as a new authorization until it receives a Verified status. The possible reasons that an authorization may be rejected include:

• Authorization signed by Deceased Beneficiary - An authorization for a beneficiary who is deceased has been requested without providing a copy of the legal documentation to confirm that the individual can sign on the beneficiary's behalf. To rectify this, upload legal documentation that confirms which individual is authorized to sign on behalf of the beneficiary such as:
  • Executor/Executrix papers;
  • Next of kin attested by court documents with a court stamp and a judge's signature;
  • Letter of Testamentary or Administration with a court stamp and judge's signature;
  • Personal representative papers with a court stamp and judge's signature;
  • Will;
  • Birth certificate, Marriage license, or Death certificate;
  • Signed/notarized statement.
• Medicare ID Does Not Match - The beneficiary's Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]) submitted on the authorization request does not match the Medicare ID on the MSPRP case. To rectify this, resubmit the authorization request with the corrected Medicare ID.
• Beneficiary Name Does Not Match - The beneficiary's name submitted on the authorization request does not match the beneficiary's name on the MSPRP case. To rectify this, resubmit the authorization request with the corrected beneficiary name.
• Date(s) of Authorization conflict with Supporting Documentation - The Authorization Start/End date(s) submitted on the Authorization Documentation page are different than the corresponding date(s) submitted on the uploaded supporting documentation. To rectify this, verify the start and end dates on the supporting documentation are correct. Submit a new authorization and ensure that the dates provided on the supporting documentation exactly match the Authorization Start Date and Authorization End Date (if applicable) you entered on the Authorization Documentation page
• DOI Not Provided - The Date of Incident submitted on the authorization request was not provided. To rectify this, re-submit the authorization request that includes the correct Date of Incident.
• Missing or Insufficient Supporting Documentation - Information is missing from the supporting documentation. To rectify this, identify what is missing, make the necessary correction(s), submit a new authorization, and upload the applicable supporting documentation.
• Missing Required Signature(s) - One or more signatures are missing from the supporting documentation (e.g., the beneficiary or attorney's signature). To correct this, obtain the missing signatures, submit a new authorization, and upload the appropriate supporting documentation
• Name on Document Does Not Match the Name Entered - The name on the supporting document does not match the name entered by an individual submitting an authorization on behalf of another person. To rectify this, resubmit the document with the appropriate name.
• Name on Document Does Not Match the Portal Submitter - The supporting document that was submitted identifies an individual to whom the information can be released but that name does not match the company name listed on the portal account by an individual submitting their own authorization. To rectify this, resubmit the document with the appropriate name.

  For example: The company name on the portal account is 'ABC Law Firm'. An authorization request is submitted for this case, but the letterhead/company name on the supporting document is for 'Mary Smith'. Since the BCRC cannot assume that 'Mary Smith' is a part of 'ABC Law Firm', the authorization request will be considered invalid. In this case, the supporting document should be re-submitted with the name, 'Mary Smith', 'ABC Law Firm'. The letterhead/company name on the supporting document must match the company name of the portal account you are uploading the supporting documentation to, otherwise the request will be considered invalid.

• No Authorizing Statement on Document - The Consent to Release that was submitted did not indicate which entity (e.g., attorney, TPA, etc.) is allowed to receive information from CMS, its agents and/or contractors. To rectify this, resubmit a new Consent to Release that clearly identifies the name, address and phone number of the entity that can receive this information.
• Other/Multiple Reasons for Authorization Being Invalid - The requirements for submission were not met for reasons other than those listed above (e.g., the uploaded authorization documentation does not match the case, or all required documentation is missing etc.). To rectify this, make all necessary corrections, submit it as a new authorization and upload all applicable supporting documentation.
• Case ID/Recovery ID Number Does Not Match - The supporting document did not match the information on the case. To rectify this, review the documentation that was uploaded and resubmit the correct documentation to the appropriate case.
• Signed by Third Party with No Supporting Documentation - An authorization was submitted by an entity but the required supporting documentation was missing. To rectify this, re-submit the required supporting documentation.