Authorization Documentation

This page provides you with the ability to view all authorizations that have been submitted for the case that are associated to the user who is currently logged in, as well as submit a new authorization.

The Centers for Medicare & Medicaid Services (CMS) will allow an individual or entity to have access to a Medicare beneficiary's personal information only if the Medicare beneficiary has provided this authorization to CMS in writing. Two types of beneficiary authorizations are Beneficiary Proof of Representation (POR) and Beneficiary Consent to Release (CTR). Another type of authorization, Recovery Agent Authorization, allows an individual or entity to work on behalf of a liability insurer, no-fault insurer, or workers' compensation entity.

For a complete description of each authorization type, please see the applicable help pages found at the following links on this page: What is Consent to Release?, What is Proof of Representation?, and What is Recovery Agent Authorization?

Authorizations

The top section of the Authorization Documentation page displays a list of authorizations that have been submitted to date for the case that are associated to the user who is currently logged in. They will be listed chronologically with the most current authorization listed first. For each submitted authorization, the following information will display:

Field	Description
Authorization Type	The type of authorization submitted. Types include: Beneficiary Consent to Release (CTR) Beneficiary Proof of Representation (POR) Recovery Agent Authorization
Status	Current status of the submitted authorization. It can be Verified, Unverified, or Invalid. For a complete description of each authorization status, view the help page found at the following link: Authorization Status Definitions? Note: You will not be able to receive correspondence until your authorization is in a Verified status.
Start Date	The date the authorization goes into effect.
End Date	The date the authorization terminates.

Submit New Authorization

The authorization process allows you to submit a request for a new authorization for a case associated with an account. To do so, you must select an authorization type along with start and end dates for the authorization;respond to the question related to who the authorization is being submitted for; upload required documentation that supports your request; and complete an attestation. The information entered on this page must match the information submitted on your supporting documentation.

About Authorization Verification

Requesting for Yourself

If you are logged in to the MSPRP and are requesting authorization for yourself for a case, you can get verified when:

You complete the required fields
You click No to the question: "Is this authorization being submitted for someone other than yourself/your company?"
You submit your supporting documentation successfully
You have checked the attestation confirming accuracy of the submission

Once submitted, you can view your status under Authorization Level on the Case Information page, as well as view the new authorization on this page, along with the authorization start and end dates.

Requesting for Another Party or Entity

If you are logged in to the MSPRP or you are a beneficiary logged in through Medicare.gov and are requesting authorization for someone other than yourself/your company for a case (so that party can perform actions on the case , receive correspondence, call customer service, etc.), this authorization can be verified when:

You complete the required fields
You click Yes to the question: "Is this authorization being submitted for someone other than yourself/your company?"
You complete the Representative Information fields (all fields are required except Representative Middle Initial and Address Line 2)
You submit your supporting documents successfully
You have checked the attestation confirming accuracy of the submission

Once submitted, when that party logs in to the MSPRP they will be able to view the status under Authorization Level on the Case Information page, as well as view the new authorization on this page, along with the authorization start and end dates.

Notes:

If you are a beneficiary who has logged in using Medicare.gov, you may submit or request an authorization for someone other than yourself, in addition to account managers and account designees.
Submitting an authorization for another party does not make them an account designee.
MSPRP users will not see the authorization level and status of other entities associated with a case on the Case Information page.
For beneficiary and insurer-debtor users, the answer to the question "Is this authorization being submitted for someone other than yourself/your company" defaults to Yes and is not editable since these users do not require authorization on their own cases

To Submit a New Authorization:

Select the authorization type by clicking the radio button next to the desired authorization.
To see model examples and blank templates of the Beneficiary POR and Beneficiary CTR, go the Medicare's Recovery Process on cms.gov. To see a model example of a Recovery Agent Authorization, go to Insurer NGHP Recovery on cms.gov.
Select the representation type for the individual or entity requesting authorization from the drop-down menu.

Notes:

If you are associated to the insurer-debtor pre-demand case as the insurer's Section 111 (S111) Recovery Agent (i.e., you were submitted as the Recovery Agent on the insurer's S111 TIN Reference File), the Authorization Type on the Authorization Documentation page will be pre-selected as Recovery Agent Authorization and you will be prevented from changing this option. The Beneficiary POR and Beneficiary CTR buttons will not be shown.

Representation Types
- Attorney - A person licensed to practice law.
- Guardian/Conservator - Appointed by a judge once it is determined that the beneficiary is incapacitated.
- Power of Attorney - A legal document giving the beneficiary's representative full legal authority to preside on the beneficiary's behalf.
- Recovery Agent - An entity hired to act on behalf of and/or represent an organization or person for a specific matter such as the recovery of a Medicare overpayment. For example, a workers' compensation carrier may hire an "agent" to assist during the Medicare recovery process and provide a Proof of Representation document allowing that agent to act on their behalf in regard to that specific case.
- Individual/Other - All other types not covered by any of the other descriptions.
Enter the Start Date of Authorization and End Date of Authorization (if applicable).
- Authorization Start Date: The date the authorization goes into effect. This field is required. It must be entered in MMDDCCYY format and it cannot be a future date. If the supporting documentation does not specify a start date, enter the date the authorization was signed by the beneficiary/representative.
- Authorization End Date: The date the authorization terminates. If the supporting documentation does not specify a termination date, this field must be left blank. If the supporting documentation specifies a termination date for the authorization, you must enter that date. If this date is entered, it must be entered in MMDDCCYY format.
If the authorization is being submitted for another party, click Yes to the question: "Is this authorization being submitted for someone other than yourself/your company?" Otherwise, click No.
Complete the Representative information, if the authorization is being submitted for another party .
Upload required documentation that supports the type of authorization requested. (See "Supporting Documentation Requirements" section.)
Click Upload Documentation. This will take you to the Documentation Upload page where you will perform the upload.
Note: Your document must not be any larger than 8.5 by 11 inches.
Click Continue.

You will be returned to the Authorization Documentation page. Verify that the correct files have been uploaded.
- If an incorrect file has been uploaded, click Delete. This will remove the file and it will not be uploaded to the case.
- If you do not want to add any of the files to the case, click Cancel. The files will not be submitted for the case and you will be returned to the Case Information page.
Check the attestation box verifying that the information being submitted is correct .
Click Continue to complete the submission process. You may Print this Page for your records.
The Authorization Documentation Confirmation page displays.

Supporting Documentation Requirements

Beneficiary Consent to Release (CTR)

Required information:

The Medicare beneficiary's name exactly as shown on their red, white, and blue Medicare card;
Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]) of the Medicare beneficiary exactly as it is shown on the Medicare card, including any letters;
Name of individual or entity to which the information may be disclosed;
When to start the request for authorization;
When to terminate the request for authorization (if applicable);
Signature of the Medicare beneficiary or the beneficiary's representative; and
Date the Medicare beneficiary signed the Consent to Release.

If you are requesting authorization for a deceased beneficiary, you must include a copy of the legal documentation which confirms that you can sign or speak on the beneficiary's behalf. For example, you can include:

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;
Birth certificate;
Marriage license;
Death certificate; or
Signed/notarized statement.

Beneficiary Proof of Representation (POR)

Required information:

A copy of a Retainer Agreement (i.e., an agreement between a client and his or her lawyer that spells out the terms of the business arrangement between them) will be accepted as Proof of Representation.

Required information if you are submitting a Retainer Agreement:

Retainer Agreement on attorney letterhead or accompanied by a cover letter on letterhead;
Beneficiary name (printed on the agreement or cover letter);
Signature of beneficiary;
Date of signature of beneficiary;
Signature of attorney; and
Date of signature of attorney.

Required information if you are not submitting a Retainer Agreement:

The Medicare beneficiary's name exactly as shown on their red, white, and blue Medicare card;
Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]) of the Medicare beneficiary exactly as it is shown on the Medicare card, including any letters;
Representation type (i.e., Attorney, Guardian/Conservator, Power of Attorney, Third Party Administrator, Individual/Other);
- If the Proof of Representation is for a Third Party Administrator, the Proof of Representation must also include a letter on the insurer's letterhead that contains:
  - A beneficiary specific statement (including the beneficiary's name and Medicare ID) on the insurer or workers' compensation entity's letterhead that the agent is representing the insurer or workers' compensation carrier with respect to a claim involving the identified Medicare beneficiary;
  - Name(s) of person(s) that have been hired; and
  - A statement as to what they are approved to do.
Firm/company name (if applicable);
Signature of beneficiary;
Date of signature of beneficiary;
Name of representative/attorney;
Signature of representative/attorney; and
Date of signature of representative/attorney.

Note: If the beneficiary is incapacitated, you must also include a court document appointing power of attorney to confirm that you can sign the Proof of Representation or speak on the beneficiary's behalf.

Recovery Agent Authorization

Required information:

An authorization, such as a Recovery Agent Authorization, is required any time that an applicable plan (such as self-insured, no-fault insurer or workers' compensation entity) is represented by an agent that will work with CMS' contractors to address coordination of benefits and recovery issues on behalf of that applicable plan.

CMS must have authorization on file for each recovery case. Any time that an applicable plan would like an agent to work on its behalf, CMS must have authorization on file.

Notes:
If an applicable plan designates an agent electronically via Section 111 reporting, further documentation does not need to be submitted unless the agent needs to act on behalf of the insurer after a demand is issued. Actions that occur after a demand is issued include requests for appeal and requests for reopening. Requests for appeal and reopening will be denied if submitted by an entity other than the applicable plan and we do not have a Recovery Agent Authorization in Verified status on file.

Recovery Agents who are associated to an insurer-debtor case as the insurer's S111 Recovery Agent may submit a Recovery Agent authorization. An S111 Recovery Agent with an active Recovery Agent authorization in Verified status also has authority on the insurer-debtor case pre- and post-demand, even if the agent was removed or replaced on the insurer's S111 TIN Reference File.

Required information if you are submitting aRecovery Agent Authorization:

It must be in writing (that is, signed and dated by both entities).
It must state that one entity appoints the other entity to act on its behalf.
It must include purpose and scope (that is, it must describe the reason for the authorization).
It must include name, phone and address of each entity. (Note: These elements are often already part of the letterhead.)
It must reference professional status or relationship between the entities (for example: attorney/client, agency, third-party administrator, etc.).
It must reference the recovery case ID, or otherwise provide information that allows CMS' recovery contractor to associate authorization to a particular beneficiary file.
It must include a timeframe for the agent's authority.
It must be submitted to CMS' recovery contractor.

Revoke, Delete or Change a Verified Authorization

To revoke, delete, or change the start and/or end dates on an existing verified authorization, you must submit your request in writing.

For PORs, CTRs, and Recovery Agent Authorizations on BCRC cases, write to:

NGHP
PO Box 138832
Oklahoma City, OK 73113
Fax: (405) 869-3309

For Recovery Agent Authorizations on CRC cases, write to:

Commercial Repayment Center - NGHP
PO Box 1610
Lathrop, CA 95330

February 2023