Case Status Definitions

Case Status Definitions

The following statuses pertain to both Benefits Coordination & Recovery Center (BCRC) and Commericial Repayment Center (CRC) cases, unless otherwise indicated.

Status	Definition
In Development	The Centers for Medicare & Medicaid Services (CMS) has been notified of a case and is in the process of gathering the information needed about the case.
Open	The recovery efforts for the case are in process by CMS. For
Claim Retrieval	CMS is in the process of obtaining claim information for payments made by Medicare that are related to the injuries/illnesses sustained by the beneficiary.
Demand (or Demand in Progress)	CMS has issued/or is in the process of issuing a formal demand letter advising the debtor of their payment responsibility. The demand letter is sent to formally advise the debtor of the amount of money owed to the Medicare program. It includes the following: a summary of conditional payments made by Medicare, the total demand amount, and, in letters to beneficiary-debtors, it includes information on applicable waiver and administrative appeal rights.
Extended Repayment	The demand has been issued, and CMS has authorized an extended repayment plan (ERP) in monthly installments for the amount due.
Bill Issued	CMS has approved the Fixed Percentage Option Request or agreed to the Self-Calculated Conditional Payment Amount and has issued a bill to the beneficiary for the amount due. Payment must be received within the timeframe specified on the bill. Notes: This status applies only to BCRC cases where the beneficiary has opted to resolve Medicare's recovery claim.
Transitioned	CMS has been notified by the insurer that the debt associated to this case is within 120 calendar days of anticipated settlement. This debt has been transferred to the beneficiary and has been placed in the Final Conditional Payment process. As a Final Conditional Payment case, the insurer and their representatives will be prevented from taking any further actions on the case. To receive copies of future recovery-related correspondence for this case, the entity must submit a proper Consent to Release or Proof of Representation signed by the beneficiary to the BCRC. Note: This status applies to CRC cases only.
Closed	CMS has terminated recovery efforts for the case. Case closure may occur when a case should not have been created. That is, the case was created for an incorrect date of incident, or the beneficiary was not eligible during the MSP coverage period. For CRC cases, this status also displays if the case is in bankruptcy. Note: If you feel that a case should not have been closed or if you want to take further action (such as filing an appeal), please contact a customer service representative at 1-855-798-2627.