The Case Information page provides you with the ability to review case information and to perform various actions on a case. The case ID shown will either be the Benefits Coordination & Recovery Center "BCRC Case ID" (BCRC insurer cases and all beneficiary cases) or the Commercial Repayment Center "CRC Recovery ID" (CRC insurer cases).

The following information will be displayed (as applicable) on this page for the selected case.

Note: Where noted, the information on this page is shown in real time each time the page is loaded. If you have access to the Open Debt Report, you may notice its information can differ from what is shown here. That is because it is refreshed nightly rather than in real time.

When the following message appears - "Some data fields are temporarily unavailable. Please try back later." - the data could not be retrieved in real time, but some normally real-time fields may show recent data instead.

Table 1: Case Information Header Fields

Field	Description
Case ID	The primary identifier assigned by the Centers for Medicare & Medicaid Services (CMS) to the case. The case ID is located on any case-specific correspondence received from Medicare such as the Rights and Responsibilities Letter or Conditional Payment Letter. The case ID is a 15-digit number in ##### ##### ##### format. Notes: BCRC case IDs begin with the number 2, and CRC case IDs begin with the number 3. If the account receives letter notification emails instead of mailed letters for the case, a green leaf icon appears next to the case ID. You may view letter notification emails for cases that are paperless on the MSPRP via the Go Paperless Letter Notifications page.
Case Type	The type of insurance coverage provided by the plan for the case. This can be any of the following: Liability Insurance - Insurance that pays on behalf of the policyholder or self-insured entity against claims for negligence, inappropriate action or inaction, which results in injury or illness to an individual or property damage. Workers' Compensation - A law or plan that requires the employer's insurance company to provide medical care or compensation for an employee who gets sick or injured on the job. No-Fault - Insurance that pays for health care services resulting from injury to an individual or damage to property in an accident, regardless of who is at fault for causing the accident.
Case Status	The current state of the case in the MSPRP system. For BCRC cases, it can be any of the following: In Development Open Claim Retrieval Demand or Demand in Progress Extended Repayment Bill Issued Closed For CRC cases, it can be any of the following: In Development Open Claim Retrieval Demand or Demand in Progress Extended Repayment Transitioned Closed For a complete description of all statuses, please see the Case Status Definitions help page.
Current Status of Debt	If the case was referred or is being referred to Treasury, this field appears. Possible values: Intent to Refer Letter Sent Debt Referral Pending Debt Referred to Treasury Debt Recalled from Treasury (Referral Exemption) Debt Returned from Treasury Debt Resubmitted to Treasury
RRE Name	Name of the Responsible Reporting Entity (RRE) who reported the case. Note: This field only appears when the case was reported via S111.
Date of Incident	The Date of Incident (DOI) (or Date of Injury) is the date defined by the Centers for Medicare & Medicaid Services (CMS).
Industry Date of Incident	The Industry DOI is a self-reported date used by the insurance/workers' compensation industry.
ORM	If ongoing responsibility for medicals (ORM) exists, this field appears, showing a value of "Yes". If no ORM exists, this field does not appear.
Medicare ID	The Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) of the beneficiary who is associated to the case. This number can be found on the beneficiary's Medicare card. The first five positions of HICN will be masked (hidden from view) with asterisks, unless you are the beneficiary, or you have logged in using multi-factor authentication .
Beneficiary DOB	The date of birth of the Medicare beneficiary associated to the case.
Beneficiary Last Name	The beneficiary's last name as it appears on the Medicare card.
Treasury Account Number	The number assigned to a debt that has been referred to Treasury.
Treasury Referral Date	The date the debt was referred to Treasury, or will be referred if the date is in the future. This field only appears if the debt was referred or will be referred to Treasury.
Authorization Level	The type of authorization (Beneficiary Proof of Representation (POR), Beneficiary Consent to Release (CTR), or Recovery Agent Authorization) that was submitted to date that has the highest authorization level associated to the user who is currently logged in. If multiple authorizations have been submitted for the case, the authorization type and authorization status with the highest authorization level will display on this page.
Authorization Status	The status of the authorization with the highest authorization level that was submitted to date associated to the user who is currently logged in. It can be: Verified Unverified Invalid Please see the Authorization Status Definitions help page for a full description of these statuses. Note: Only one authorization type and authorization status will appear on this page. To view all submitted authorizations associated to the user who is currently logged in, select the View / Request Authorizations (i.e., Beneficiary POR, Beneficiary CTR, or Recovery Agent Authorization) action and then click Continue.
What is this?	Click this link to view the Authorization Status Definitions help page for a full description of these statuses.
ORM Termination Date	The date ORM ended, if ORM has been terminated, or blank, if ORM has not been terminated. If no ORM exists, this field does not appear.

Table 2: Payment Information Tab Fields

This is the default tab that will display when you access the Case Information page.

Field	Description
Current Conditional Payment Amount	This is the total conditional payment amount. Notes: A conditional payment is a payment Medicare makes for services on behalf of a Medicare beneficiary when another payer may be responsible. The payment is "conditional" because it must be repaid to Medicare when a settlement, judgment, award, or other payment is reached. As new claims are received and processed, the current conditional payment amount will be updated. A red asterisk (*) and a note that explains the asterisk will appear below this field, indicating that claims are retrieved daily and the date the current conditional payment amount was last calculated. If claim processing is ongoing, the note will indicate the expected timeframe of 3-5 days, and give a number to call if an updated amount is needed sooner.
Rights and Responsibilities Letter Mail Date	The date the Rights and Responsibilities Letter was sent by CMS to the beneficiary and/or the entity responsible for repayment of a debt owed to Medicare. This letter is sent when CMS first learns of the case. The letter confirms that a Medicare Secondary Payer (MSP) recovery case has been established and educates the recipient about Medicare's right of recovery. Note: These letters are sent only for BCRC cases; not CRC cases.
Conditional Payment Letter Amount	The conditional payment amount listed in the Conditional Payment Letter (CPL). This amount will be zero if No Claims Paid by Medicare Letter (NCP) was sent instead of a CPL. This field is blank when neither letter was sent.
Conditional Payment Letter Mail Date	The date the CPL or the NCP was mailed to the addressee. If no CPL or NCP date is available, then "N/A" appears in the field. Note: The CPL is automatically sent within 65 days of the Rights and Responsibilities letter for BCRC cases. It may be sent subsequently upon request.
Conditional Payment Amount Update Requested	The date a user initiated the Request an update to the conditional payment amount action. This field will only display when this action has been taken.
Demand Letter Mail Date	The date the Demand Letter was sent by CMS.
Demand Amount	The amount the debtor is required to repay Medicare. This amount is noted in the Demand Letter.
Interest Rate	The interest rate for the case associated with the demand. Note: If no data is available, this field will appear as blank.
Last Interest Accrual Date	The date interest last accrued on the case. Note: If no data is available, this field will appear as blank.
Total Interest Accrued	The real-time total interest accrued on the debt.
Section 111 No-Fault Policy Limit Reported	The reported policy limit. Notes: This field only appears for Section 111 No-Fault CRC cases. If the policy limit submitted consists of all 9s (i.e., indicating no dollar limit), this field will display "Unlimited."
Conditional Payment Notice Amount	The Final Conditional Payment Amount listed on the CPN letter.
Conditional Payment Notice Mail Date	The date the CPN letter was mailed. If multiple CPN letters were mailed, this field displays the most recent date.
Conditional Payment Notice Response Due Date	The date the CPN response is due, as listed on the letter. If multiple CPN letters were mailed, this field displays the most recent date.
Balance Amount	The real-time total Accounts Receivable (AR) balance amount for the case. Note: If no data is available, this field will appear as blank.
Balance as of Date	The current date (as data is retrieved in real time). Note: If no data is available, this field will appear as blank.
Remaining Principal Balance Amount	The real-time total AR remaining principal balance amount for the case. Note: If no data is available, this field will appear as blank.
Principal Activity Amount	The amount the principal has been adjusted, whether through payment or successful appeal.
Remaining Interest Balance Amount	The real-time total AR remaining interest balance amount for the case. Note: If no data is available, this field will appear as blank.
Interest Activity Amount	The amount the interest has been adjusted, whether after payment or successful appeal.
Make a Payment	Click this button to open the Make a Payment page and begin the process of submitting a payment for a demand. Note: This button is only enabled if you are the debtor, insurer representative (with a verified Recovery Agent Authorization for an insurer-debtor case), or a user with a verified POR on file. Additionally, the demand letter must be generated and the demand balance amount minus any pending electronic payments must be more than zero ($0.00).

Table 3: Electronic Payment History Tab Fields

This is the default tab that is displayed when you access this page from the Payment Status page. This tab lists payment history details for electronic payments submitted on Pay.gov; it is only displayed when there is electronic payment data for the case.

Note: To verify if a paper check was received, please click the Correspondence Activity tab and select Correspondence Received.

Field	Description
Demand Letter Mail Date	The date the Demand Letter was sent by CMS.
Demand Amount	The final amount the debtor is required to repay Medicare. This amount is noted in the Demand Letter.
Remaining Principal Balance Amount	The real-time total remaining principal balance amount for the case.
Remaining Interest Balance Amount	The real-time total remaining interest balance amount for the case.
Total Remaining Balance Amount	The real-time total remaining balance amount for the case. This amount includes principal and interest.
Payment Date	The date the electronic payment was submitted on Pay.gov.
Payment Method	The type of payment submitted on Pay.gov. Possible values: ACH (Automated Clearing House) Debit Card PayPal Unknown
Account Holder Name	The name of the account holder.
Payment Amount	The amount of the payment submitted on Pay.gov.
Pay.gov Payment Status	The status of the payment submitted on Pay.gov. Possible values: Accepted Cancelled Declined Pending Reversal Unknown
Pay.gov Confirmation Number	The transaction ID number for the payment submitted on Pay.gov.
Demand Balance Status	The status of the Demand Balance. Possible values: Blank: Payment not accepted or in process at Pay.gov. In Process: Payment is accepted at Pay.gov, but not applied to the AR balance. Complete: Payment is accepted at Pay.gov, applied to the AR balance, and the balance is updated on the MSPRP.
Demand Balance Update Date	The date the Demand Balance Status changed to Complete (MM/DD/YYYY).

Table 4: Refund Information Tab Fields

This tab will only display when there is refund data to display, i.e., at least one refund has been generated for the case.

Field	Description
Demand Letter Mail Date	The date the Demand Letter was sent by CMS.
Balance Amount	The real-time total balance amount for the case. Note: If no data is available, this field will appear as blank.
Demand Amount	The final amount the debtor is required to repay Medicare. This amount is noted in the Demand Letter.
Balance as of Date	The current date (as data is retrieved in real time). Note: If no data is available, this field will appear as blank.
Refund Date	The refund date (MM/DD/YYYY).
Refund Amount	The refund amount ($0.00).
Check Number	The check number (numeric up to 10 characters).
Payee Name	The payee name (first and last, up to 60 characters).

Table 5: Correspondence ActivityTab Fields

This tab lists read-only details related to correspondence that has been received or letters that have been sent related to a BCRC or CRC case. This tab only appears when there is correspondence to display.

Users may select how they want to view the list of case correspondence. Options include: all correspondence received and all letters sent; correspondence received; and letters sent. The default view is all correspondence. Authorized users may also use the Correspondence Type hyperlink to view and print PDFs of outgoing correspondence for beneficiary-debtor and insurer-debtor cases.

Field	Description
Select the correspondence option you wish to view	Options for viewing correspondence. Possible values: All Correspondence Received and All Letters Sent Correspondence Received Letter Sent
Correspondence Type	The description of the correspondence. Note: For outgoing correspondence, click the hyperlinked correspondence type to open a PDF of the letter. The Images for Correspondence Type page will appear instead if there is more than one image related to the letter. This page will allow you to view details for the outgoing letter and PDFs of all available images of the letter and its attachments. This hyperlink is only available for authorized users: those who have logged in with multi-factor authentication and who have a verified CTR, POR, or Recovery Agent Authorization to view case information. See the Case Information page header if you are unsure whether you have that authorization.
Uploaded Document Name	Displays the filename of the uploaded documents. Note: This column will be blank for documents not uploaded on the MSPRP.
Date Received	The date the correspondence was received (MM/DD/CCYY).
Date Sent	The date the correspondence was sent (MM/DD/CCYY). Note: This column is blank for documents received through mail or fax or uploaded on the MSPRP.
Status	The status of the correspondence. Possible values: Open - New or Pending (incoming only) Closed - Resolved (incoming only) Sent (outgoing only)
Status Date	The date associated with the Status of the correspondence. Possible values: If the Status is "Open," this will be the Date Received. If the Status is "Closed," this will be the date the correspondence was closed. If the Status is "Sent," this will be the Date Sent.

Table 6: Waiver/Redetermination/Appeal/Compromise Tab (BCRC case)/Redetermination/Appeal Tab (CRC case) Fields

This tab displays only when a waiver, redetermination, or a compromise has been submitted for a case. The tab label that displays is dependent upon the type of case you are viewing. Since waiver and compromise submissions are not applicable to a CRC case, the tab label will display "Redetermination/Appeal" when viewing this case type. If you are viewing a BCRC case, the tab label displays as "Waiver/Redetermination/Appeal/Compromise." When viewing a case, all information for each submitted waiver and compromise (either submitted in the mail or received on the portal) are displayed; however, only information for the first redetermination submission received is displayed.

Sub-tables will display information for waiver, redetermination, and/or compromise submissions, but will only appear when there is data to display in a table.

Field	Description
Waiver Information	-
Received	The date the waiver request was received (MM/DD/YYYY).
Decision	The decision made regarding the waiver request, as applicable. Values may include: Denial (Hardship Criteria) Denial (Equity and Good Conscience Criteria) Denied (Ineligible for waiver request) Dismissed Dismissed - Missing/Invalid POR Dismissed - Medicare Demand not issued Duplicate Request Fully Favorable (Hardship Criteria) Fully Favorable (Equity and Good Conscience Criteria) Partially Favorable (Hardship Criteria) Partially Favorable (Equity and Good Conscience Criteria) Note: Until a decision has been made, the decision status "Pending Review" will display in this field.
Decision Date	The date a decision was made regarding the waiver request (MM/DD/YYYY).
Redetermination Information	-
Received	The date the redetermination was received either on the MSPRP or by mail.
Decision	The decision regarding the redetermination. Values may include: Pending Review: The redetermination decision is under review. Denied Dismissals: We have considered and reviewed your request. However, based on the information submitted, we were not able to process it Dismissed - Missing documentation Dismissed - Not authorized to appeal Dismissed - Untimely filing Dismissed - Due to interest Dismissed - Missing/Invalid POR Favorable: All of the claims submitted with your request have been removed from your case and will no longer be included with the amount owed to Medicare. Partially Favorable: Some of the claims submitted with your request have been removed from your case and the rest will continue to be included with the amount owed to Medicare. Unfavorable: None of the claims submitted with your request have been removed from your case and will continue to be included with the amount owed to Medicare. Duplicate Request
Decision Date	The date the redetermination decision was made. If a decision has not been made, this field will be blank.
Qualified Independent Contractor (QIC) Information	Note: This section only populates when a request for QIC review has been submitted.
Received	The date the QIC appeal was received (MM/DD/CCYY).
Decision	The decision regarding the QIC appeal request. Values may include: Pending Review: The QIC appeal decision is under review. Dismissals: We have considered and reviewed your request. However, based on the information submitted, we were not able to process it. Favorable: All of the claims submitted with your request have been removed from your case and will no longer be included with the amount owed to Medicare. Partially Favorable: Some of the claims submitted with your request have been removed from your case and the rest will continue to be included with the amount owed to Medicare. Unfavorable: None of the claims submitted with your request have been removed from your case and will continue to be included with the amount owed to Medicare. Duplicate Request
Decision Date	The date the QIC appeal decision was made (MM/DD/CCYY).
Administrative Law Judge (ALJ) Information	Note: This section only populates when a request for ALJ review has been submitted.
Received	The date of submission of the ALJ review (MM/DD/CCYY).
Decision	The decision regarding the ALJ review request. Values may include: Pending Review: The ALJ review decision is under review. Dismissals: We have considered and reviewed your request. However, based on the information submitted, we were not able to process it. Favorable: All of the claims submitted with your request have been removed from your case and will no longer be included with the amount owed to Medicare. Partially Favorable: Some of the claims submitted with your request have been removed from your case and the rest will continue to be included with the amount owed to Medicare. Unfavorable: None of the claims submitted with your request have been removed from your case and will continue to be included with the amount owed to Medicare. Duplicate Request Hearing Scheduled (for CRC cases only)
Decision Date	The date the ALJ review decision was made (MM/DD/CCYY).
Compromise Information	-
Received	The date of submission of the compromise (MM/DD/YYYY).
Decision	The decision regarding the compromise request. When the BCRC reviews the compromise request and determines the request has some type of issue, the values may include: Closed - Insufficient Information Closed - Invalid Authorization Closed - Case Referred to Treasury Closed - Compromise Request Withdrawn Closed - Duplicate Request When the compromise is referred to the RO, the values may include: Fully Favorable Partially Favorable Denied Denied (not the debtor) Complete. Contact the BCRC for more information. Duplicate Request Note: When a decision is pending, the decision status "Pending Review" will display in this field.
Decision Date	The date the compromise decision was made (MM/DD/YYYY).

Table 7: Final Conditional Payment Process Tab Fields

This tab will display only for cases in the Final Conditional Payment process

Field	Description
Final Conditional Payment Status	The current Final Conditional Payment Status. Status options include: Active - User has initiated the Final Conditional Payment process. Pending NOS - User has requested their Final Conditional Payment Amount. Complete - User has completed their required actions as specified by the Final CP process. Voided - User has failed to successfully complete their required actions in the Final CP process. Void in Progress - Case Unavailable - Displayed when a user did not successfully complete the required actions in the Final conditional Payment process and the case is in the process of being voided .
Final Conditional Payment Status Date	The date the Final Conditional Payment Status was updated.
Final Conditional Payment Process Initiated	The date the Final Conditional Payment process was initiated.
Request Final Conditional Payment by	The latest date a user can select the Calculate Final Conditional Payment Amount action. This date is equal to the Final Conditional Payment Process Initiated date plus 120 calendar days. If the Final Conditional Payment Status equals Voided, this field will be blank.
Final Conditional Payment Requested	The date and timestamp when the Final Conditional Payment amount was calculated.
Final Conditional Payment Amount	The Final Conditional Payment Amount of the case.
120 days' Notice of Anticipated Settlement Mail Date	The date that the 120 days' Notice of Anticipated Settlement letter (NAS) was sent.

Case Actions

The following actions can be performed on any case that is in an Open and Active status:

Some actions may not be available (or visible) depending on your authorization level and the type of case. The following sections discuss these actions and requirements in detail. You can also click the What is this? link next to each of these options for additional details.

• View/Request Authorizations
• Request an update to the conditional payment amount
• Request an Electronic Copy of the Conditional Payment Letter with Current Conditional Payment Amount
• Request a mailed copy of the conditional payment letter
• Begin Final Conditional Payment Process and Provide 120 Days' Notice of Anticipated Settlement
• Calculate Final Conditional Payment Amount
• Request an electronic Dispute Denial for Final Conditional Payment Case Letter with Current Conditional Payment Amount
• View / Dispute Claims Listing
• View/Provide the Notice of Settlement Information
• Initiate Demand Letter
• View/Submit Redetermination (First Level Appeal)
• Submit Waiver Request
• Submit Compromise Request
• Submit Case Documentation

Notes:

The View/Request Authorizations, Request an update to the conditional payment amount, and Request a mailed copy of the conditional payment letter actions cannot be selected for a BCRC or CRC NGHP ORM case related to a deleted Section 111 lead. Contact the BCRC or CRC for additional information.

None of the case actions can be selected for a case when the Fixed Percentage Option has been elected.

The Request an electronic conditional payment letter with Current Conditional Payment Amount, Request a mailed copy of the conditional payment letter, and Initiate Demand Letter actions cannot be selected for a CRC NGHP case that has an Insurer debtor with a hold. Contact the CRC for additional information.

The case debtor (beneficiary or insurer) can perform all the available actions on a case without authorization. Authorization applies only to users working on behalf of the case debtor.

The Submit Case Documentation button can't be selected for CRC cases that were referred to Treasury.

View / Request Authorizations

Who Can Access?

Available to all users.

Other Requirements?

This action is not available for a BCRC or CRC NGHP case related to a deleted Section 111 lead.

This option allows a user to view previously submitted authorization(s) and/or submit new authorizations (Types: Beneficiary POR, Beneficiary CTR, or Recovery Agent Authorization) for a case associated with an account. Please see the following help pages for more information regarding these authorizations: What is Proof of Representation?, What is Consent to Release? and What is Recovery Agent Authorization?

It is recommended that you upload and submit the proper authorization on the MSPRP as soon as CMS is made aware of the case. CMS cannot communicate with the beneficiary's or insurer's representative until the status of the submitted authorization is verified. No authorization is required for the debtor associated to a case.

Users who are logged in to the MSPRP may request a new authorization for themselves or for another party. When requesting a new authorization, 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. (Note: Authorization for another party does not make them an account designee. However, the party can perform actions on the case, receive correspondence, call customer service, etc.)

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 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.

If you are associated to the insurer-debtor pre-demand case as the insurer's S111 Recovery Agent and you submit authorization documentation on an Insurer-debtor case, the Authorization Type on the Authorization Documentation page will be pre selected as Recovery Agent Authorization and you will be prevented from changing this. The Beneficiary POR and Beneficiary CTR buttons will not be shown.

The Conditional Payment Letter will not be automatically sent out after an authorization is submitted. You must select the Request a copy of the conditional payment letter to have the system generate the Conditional Payment Letter.

Request an update to the conditional payment amount

Who Can Access?

• BCRC and CRC Cases: Available to all users - no authorization required.

Other Requirements?

This action can only be performed when the Case Status on the Case Information page is Open and the case is not in bankruptcy proceedings.

This action is not available for a BCRC or CRC NGHP case related to a deleted Section 111 lead.

This option allows a user to request CMS to re-calculate the current conditional payment amount (see Notes). The conditional payment amount is an amount paid by CMS for services on behalf of a Medicare beneficiary when there is evidence that another payer may be responsible. These payments are referred to as conditional payments because the money must be repaid to CMS when a settlement, judgment, award, or other payment is secured. The total of these payments is the Conditional Payment Amount.

The conditional payment amount is an interim amount. CMS may continue to make conditional payments for items and/or services related to the case while the case is pending. When this action is selected, all medical claims related to the case that may have been paid by CMS subsequent to the last time the conditional payment amount was calculated will be retrieved and included in the current conditional payment amount.

Notes:

When this action is selected and the Current Conditional Payment Amount displays the amount and the date it was last updated, the MSPRP will not automatically generate a conditional payment letter. If you require a hardcopy letter with the updated conditional payment information, select the Request a copy of the conditional payment letter action on the Case Information page.

For all cases, claims are retrieved daily. The MSPRP displays claims information for your case on the Case Information page. The current conditional payment amount is displayed in the Current Conditional Payment Amount field.

Request an Electronic Copy of the Conditional Payment Letter with Current Conditional Payment Amount

Who Can Access?

• BCRC Beneficiary-Debtor Cases: Beneficiaries and their authorized representatives who have an existing verified POR on the MSPRP and who have logged in to the MSPRP using multi-factor authentication.
• BCRC or CRC Insurer-Debtor Cases: Insurers, recovery agents on the TIN reference file, and insurer representatives with a verified recovery agent authorization who have logged in to the MSPRP using multi-factor authentication. Beneficiaries and their authorized representatives who have an existing verified POR on the MSPRP and who have logged in to the MSPRP using multi-factor authentication also have access.

Other Requirements?

This action can only be performed when a case meets the following criteria:

• The Case Status on the Case Information page is Open,
• A Conditional Payment Notice (CPN) or demand:
  • Has not been issued previously or is not pending, or
  • Was previously issued in error, and
• Automated processing and initial claims retrieval are complete for the case,
• No claims on the Claims Listing page are in dispute,
• The total count of Part-A claims and Part-B claim lines actively associated to the case is less than or equal to 1,500,
• The beneficiary has not accepted the self-calculated conditional payment option or entered into a Fixed Percentage Agreement.

This option allows beneficiaries and other authorized users who have logged into the MSPRP using multi-factor authentication to submit a request for an electronic Conditional Payment Letter (eCPL), which includes the associated case and claims information, in PDF format. Once displayed, there are options to save or print the letter.

When requested, the eCPL always contains current conditional payment and claims information. However, if the Current Conditional Payment Amount is equal to zero ($0.00) and the case is not in the Final Conditional Payment process (that is, the Final Conditional Payment Status is not Active, Pending NOS, or Complete) (BCRC cases only), an Electronic No Claims Paid by Medicare letter is generated. A Payment Summary Form is not displayed with this letter.

The MSPRP does not save previously generated electronic payment letters that you can later access or print. Additionally, the electronic letter will not be mailed to other authorized representatives associated to the case.

Note: When this action is selected, the MSPRP will not automatically update the Current Conditional Payment Amount. To obtain an updated Conditional Payment Letter that reflects an updated Conditional Payment Amount, click the Request an update to the conditional payment amount action first and then select Request an electronic conditional payment letter with Current Conditional Payment Amount once the amount has been updated.

If this action is selected for a BCRC case in the Final Conditional Payment process, the electronic version of the traditional conditional payment letter will not be generated. Instead:

1. If this action is selected for a case where the Final Conditional Payment Status is set to Active, the electronic version of the Notice of Anticipated Settlement Letter and Payment Summary Form will be generated and displayed.
2. If this action is selected for a case where the Final Conditional Payment Status is set to Pending NOS or Complete, the electronic version of the Final Conditional Payment Letter and date and time-stamped Payment Summary Form will be generated and displayed. The total conditional payments included on this form will constitute the final conditional payment amount if settlement is reached within 3 business days of the "Final CP Amount Requested Date" that is displayed on this Payment Summary Form.

Request a (mailed) copy of the conditional payment letter

Who Can Access?

• BCRC Cases: No authorization required. Letter goes to the beneficiary and authorized parties on the case. Option is not available for a case in the Final Conditional Payment Process if the Final Conditional Payment Status is set to Pending NOS or Complete.
• CRC Cases: No authorization required.

Other Requirements?

• The Case Status on the Case Information page is Open.
• Case has completed the initial claims retrieval and automation process.
• Current Conditional Payment Amount must be greater than or equal to zero ($0.00).
• Not available if a CPN or demand has been sent or is pending on the case (unless the CPN or demand was previously issued in error).
• No claims are in dispute (i.e., no claims have a faded checkmark in the Dispute checkbox on the Claims Listing page).
• The case is not in bankruptcy proceedings.
• Not available for a BCRC or CRC NGHP case related to a deleted Section 111 lead.

This option allows a user to request a mailed copy of the Conditional Payment Letter for either a BCRC or CRC case. The letter that is generated is a new letter, not a copy of the last conditional payment letter that was sent. It will include the current conditional payment amount that is reflected in the Current Conditional Payment Amount field. It will also include a Payment Summary Form that lists each claim that is included in the Current Conditional Payment Amount.

If the overpayment or Current Conditional Payment Amount is equal to zero ($0.00), and the case is not in the Final Conditional Payment process (that is, Status is not Active, Pending NOS, or Complete), a No Claims Paid by Medicare letter is generated.

If this action is selected for a BCRC case in the Final Conditional Payment process where the Final Conditional Payment Status is set to Active, a mailed copy of the Notice of Anticipated Settlement Letter and Payment Summary Form will be created.

The date of the new letter will be the date the letter was requested plus five business days. Please see the following help page for more information: Request a copy of the conditional payment letter.

Note: When this action is selected, the MSPRP will not automatically update the Current Conditional Payment Amount. To obtain an updated Conditional Payment Letter that reflects an updated Conditional Payment Amount, select the Request an update to the conditional payment amount action first. The claims information for your case on the Case Information page will display the conditional payment amount as of the previous day. Once you verify this amount, select the Request a copy of the conditional payment letter.

The MSPRP will create and send the Conditional Payment Letter to each authorized individual/entity (i.e., the beneficiary, the insurer if the insurer is the debtor, and each individual/entity with a verified Beneficiary POR or Beneficiary CTR on file for the case).

Begin Final Conditional Payment Process and Provide 120 Days' Notice of Anticipated Settlement

This option allows users to notify the BCRC that a specific case is approaching settlement and request that the case be a part of the Final Conditional Payment process. Once this process begins, users are required to:

• Request the Final Conditional Payment Amount on the MSPRP within 120 calendar days from the date the Final Conditional Payment process was initiated,
• Settle the case within 3 business days of requesting the Final Conditional Payment Amount, and
• Submit settlement information on the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.

Who Can Access?

BCRC Cases: Available to the identified beneficiary-debtor and their authorized representatives who have verified PORs.

CRC Cases: Available to the identified insurer-debtor and their authorized representatives who have verified Recovery Agent Authorizations.

Other Requirements?

This option is not available if:

• The Final Conditional Payment Process Initiated date has been set
• The case has Ongoing Responsibility for Medicals (ORM) that has not been terminated
• You are not the identified debtor/authorized representative for the identified debtor
• There is an existing BCRC case for the same lead
• The case has a Fixed Percentage Agreement
• The case has a Self-Calculated Conditional Payment Amount
• The case is a No-Fault case
• A CPN has been issued (BCRC cases only)
• Any special projects case
• A case where settlement information has been entered or TPOC information has been provided for the case.

Calculate Final Conditional Payment Amount

This option allows a user to self-calculate a Final Conditional Payment amount for a case in the Final Conditional Payment process, and enabled for a Final Conditional Payment case, and where the Final Conditional Payment Status is set to Active. This option is unavailable if the Final Conditional Payment amount has already been calculated.

Users must select this option within 120 calendar days of the case entering the Final Conditional Payment process otherwise the case will be voided for the Final Conditional Payment process.

Who Can Access?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Other Requirements?

This option is unavailable if there is a pending dispute on one or more claims or line items associated with the case, or if the Calculate Final Conditional Payment Amount action has already been selected.

Request an Electronic Dispute Denial for Final Conditional Payment Case Letter with Current Conditional Payment Amount

This option is for a Final Conditional Payment Case in an Active Final CP Case Status where at least one submitted dispute was denied after the Final Conditional Payment process was initiated. It allows users to request an electronic Dispute Denial for Final Conditional Payment Case Letter that displays the current Conditional Payment Amount.

This letter, along with the Payment Summary Form, will be created and displayed in separate browser windows. The electronic Dispute Denial for Final Conditional Payment Case Letter and the Payment Summary Form will both display in .PDF format. The Payment Summary form will include all active claims related to the case.

Note: The electronic Dispute Denial for Final Conditional Payment Case Letter and the Payment Summary Form can be saved and/or printed.

Who Can Access?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization who have logged in to the MSPRP using multi-factor authentication, and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Other Requirements?

To request this letter, the Final CP status on the case cannot be Voided, Void in progress, or Inactive.

View/Dispute Claims Listing

This option allows a user to view and/or dispute claims that are included in the Current Conditional Payment Amount.This action is only available if a CPN or CPL has been issued.

If a case has been Demanded, or has completed or is pending settlement in the Final Conditional Payment process, clicking this action redirects the user to the Demand Claims Listing page instead of the Claims Listing page. This read-only page displays information regarding the demanded claims for the selected case, such as the date the Demand letter was sent and the Demand amount.

Who Can View Claims?

• BCRC Cases: Beneficiaries, case debtors, or users with verified Beneficiary POR, Beneficiary CTR, or Recovery Agent Authorization, as long as their credentials pass all other existing rules for allowing access to the View/Dispute Claims option.
• CRC Cases: Case beneficiaries or users with verified Beneficiary POR or Beneficiary CTR, case debtors (insurers) and insurer representatives with a verifiedRecovery Agent Authorization.

Who Can Dispute Claims?

• BCRC Cases: Users must be the case beneficiary, the case debtor, or have verified Beneficiary POR or Recovery Agent Authorization.
• CRC Cases: - Users must be an insurer debtor or an authorized insurer representative with a verified Recovery Agent Authorization. Beneficiaries, or their representatives, cannot dispute claims.

Other Requirements?

The overpayment amount must be greater than zero ($0.00).

Disputing a claim means that you are requesting CMS to remove the claim from the Current Conditional Payment Amount because it is not related to the injury/illness sustained by the beneficiary. If CMS agrees that the claims are not related to the case, the claims will be removed from the Claims Listing page and the conditional payment amount will be adjusted accordingly.

Note: If the case has been demanded, you will not be able to dispute the claim.

View/Provide the Notice of Settlement Information

This option allows a user to submit notice of settlement information for a beneficiary-debtor case (pre-demand) that includes the ability to request the Fixed Percentage Option. For more information on the Fixed Percentage Option, please see the following help page: What is the Fixed Percentage Option?

Note: Users cannot provide notice of settlement information for insurer debtor-cases (BCRC or CRC).

When this action is selected post-demand, users will be directed to the View Settlement Information page, a read-only version of the Settlement Information page.

Once a case has settled, notice of the settlement must be transmitted to Medicare so that the reimbursement process can be brought to a conclusion. Please see the following help page for more information: Settlement Information.

Note: A notice of settlement is an agreement between one or more parties to a legal proceeding that declares the settlement and the settlement terms of the dispute. At a minimum, this document contains the following information:

• Amount of Settlement,
• Date of Settlement,
• Attorney's Fees (if any), and
• Procurement Costs (if any).

Who Can Provide the Notice of Settlement?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Who Can View Settlement Information?

• BCRC Beneficiary-Debtor Cases: Users with a verified beneficiary POR or verified beneficiary CTR authorization and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Other Requirements?

• The overpayment amount must be greater than zero ($0.00).

No claims are in dispute (i.e., no claims have a faded checkmark in the Dispute checkbox on the Claims Listing page). For settlement information questions, please mail or fax your questions to:

NGHP
PO Box 138832
Oklahoma City, OK 73113
Fax: (833) 844-1540

Initiate Demand Letter

The Initiate Demand Letter action provides authorized users with the ability to agree early with the updated Conditional Payment Amount identified in the Conditional Payment Notice (CPN) and trigger the issuance of the demand for BCRC and CRC cases.

For a case where the beneficiary is the debtor, the Initiate Demand Letter Confirmation page allows a beneficiary to verify the settlement information that was previously submitted by viewing information displayed. If any of the settlement information is missing or incorrect, the beneficiary can click the Update Settlement Information button before initiating a request for a demand letter.

Who Can Initiate a Demand Letter?

• BCRC Cases: Users must be the case debtor, or have verified Beneficiary POR or Recovery Agent Authorization.
• CRC Cases: Users must be the case debtor or an authorized insurer representative with a verified Recovery Agent Authorization.

Other Requirements?

• There are no duplicate claims, no disputes are pending, and all correspondence for the case has been resolved,
• The case (BCRC only) is not active in the Final Conditional Payment process (i.e., the Final Conditional Payment Status is not Active, Pending NOS, or Complete, or a void is in progress),
• A CPN was mailed (BCRC and CRC cases),
• The case (BCRC and CRC) is not in Demand, Demand in Progress, or Closed status, and
• A demand was not previously requested on the MSPRP or was not previously mailed (unless it was mailed in error).

View/Submit Redetermination (First Level Appeal)

Once a demand letter has been sent, the View/Submit Redetermination (First Level Appeal) action will be available to the users described below for BCRC or CRC NGHP cases. This action provides beneficiary-debtors and insurer-debtors, or their verified authorized representatives, with the ability to submit a redetermination request (first-level appeal) on the MSPRP. After a redetermination request is submitted on the MSPRP, users can click this action to submit further redetermination requests or to view redetermination status information for the case including the Redetermination Received Date, Redetermination Decision, and the Redetermination Decision Date.

Who Can Submit a Redetermination?

• BCRC Cases: User must be the case beneficiary, the case debtor, or have a verified beneficiary POR (for a beneficiary-case), or be an insurer representative with a verified Recovery Agent Authorization (for an insurer-debtor case).
• CRC Cases: User must be the case debtor or an authorized insurer representative with a verified Recovery Agent Authorization.

Who Can View a Redetermination?

• BCRC Cases: User must be the case beneficiary, the case debtor, or have a verified beneficiary POR or CTR (for a beneficiary-debtor or insurer-debtor case), or be an insurer representative with a verified Recovery Agent Authorization (for an insurer-debtor case).
• CRC Cases: User must be the case beneficiary, the case debtor, or have a verified beneficiary POR or CTR, or be an insurer representative with a verified Recovery Agent Authorization.

Other Requirements to Submit a Redetermination Request?

• The case must be in a Demand Issued status and a demand letter has been sent for the case (as determined by the Demand Letter Mail Date).
• A redetermination request was not previously submitted in the mail or on the MSPRP.
• A redetermination must be submitted within 120 days from the date of receipt of the demand letter.

Other Requirements to View a Redetermination Request?

• Redetermination request must have been previously submitted on the MSPRP.

Submit Compromise Request

The Submit Compromise Request action allows you to submit a request that the Medicare program grant a compromise for the amount you owe on a debt and accept a lesser amount. A compromise is an offer for Medicare to accept less than the amount Medicare is due. You can request a compromise after the case settles and funds have been paid.

When you submit a compromise request, you must must state the reason why you believe a compromise should be granted and provide supporting information or documentation by entering a text explanation or uploading documentation (evidence).

Who Can Submit a Compromise Request?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Other Requirements for a Compromise Request

• The case must be in Bill Issued, Demand Issued, or Demand in Process status.
• All previous compromise requests associated with the case must be closed.

Submit Waiver Request

The Submit Waiver Request action allows you to submit a request for a waiver on the MSPRP. A waiver is when all or part of the demand amount owed is dismissed. This action is only available if a waiver has not yet been submitted on the MSPRP or sent in the mail.

You have the right to request that the Medicare program waive recovery of the demand amount owed in full or in part. The Medicare program may waive recovery of the amount owed if the following conditions are met:

• You are not at fault for Medicare making conditional payments, and;
• Paying back the money would cause financial hardship or would be unfair for some other reason, and;
• A demand letter has been sent for the case.

You must provide supporting information or submit supporting documentation to back up your request. The SSA 632 Request for Waiver form is recommended if you are claiming financial hardship. A hyperlink to the form is available during the waiver request process. You can also submit additional documents to support your request.

Who Can Submit a Waiver Request?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization and beneficiaries.
• CRC Cases: None. Option is not available (or visible) to any users.

Other Requirements for a Waiver Request on the MSPRP

• No outstanding waiver request exists for your case.
• A demand letter has been sent.

Submit Case Documentation

The Submit Case Documentation action allows you to submit documentation for a BCRC or CRC case. This option is unavailable for a CRC case if the case has been referred to Treasury.

You may submit the following documentation for BCRC and CRC cases:

• Additional Redetermination Documentation
• Additional Waiver Documentation (BCRC cases only)
• Exhaust Letter/Insurance Documentation
• Freedom of Information Act Request
• Refund Request (CRC-owned cases only)
• Status Inquiry/Other

Note: You will only be able to select the Additional Waiver Documentation or Additional Redetermination Documentation document types if a waiver or redetermination was previously submitted and is pending a resolution or if a previous waiver or redetermination was dismissed.

Who Can Access?

• BCRC Beneficiary-Debtor Cases: Users with a verified Beneficiary POR authorization and beneficiaries.
• BCRC or CRC Insurer-Debtor Cases: Case Debtor and Insurer representatives with a verified Letter of Authority (LOA).

Other Requirements?

• This option is available for any BCRC case.
• This option is available for any open or closed CRC case if the case has not been referred to Treasury.

Action Navigation

Click Continue to advance to the subsequent page for the action. The subsequent page is dependent upon the radio button selected (see chart below):

Table 8: Action Navigation

Selected Radio Button	Subsequent Page
View/Request Authorizations (POR, CTR, orRecovery Agent Authorization)	Authorization Documentation
Request an update to the conditional payment amount	Conditional Payment Request Confirmation Page
Request an electronic copy of the conditional payment letter with Current Conditional Payment Amount	Electronic Conditional Payment Letter Confirmation for a case that is not in the Final Conditional Payment Process Electronic Notice of Anticipated Settlement Letter Confirmation page when the MSPRP Final Conditional Payment Status is Active. Electronic Final Conditional Payment Letter Confirmation when the MSPRP Final Conditional Payment Status is Pending NOS or Complete. No Claims Paid by Medicare Confirmation when the Current Conditional Payment Amount is equal to zero ($0.00) and the case is not in the Final Conditional Payment process.
Request a mailed copy of the conditional payment letter	Conditional Payment Letter Confirmation Page (for a case that is not in the Final Conditional Payment Process) Notice of Anticipated Settlement Letter Confirmation page when the MSPRP Final Conditional Payment Status is Active. No Claims Paid by Medicare Confirmation when the Current Conditional Payment Amount is equal to zero ($0.00) and the case is not in the Final Conditional Payment process.
Begin Final Conditional Payment Process and Provide 120 Days' Notice of Anticipated Settlement	WARNING - 120 day Notification Action Can Only Be Selected Once
Calculate Final Conditional Payment Amount	WARNING - Calculate Final Conditional Payment Amount Can Only Be Selected Once
Request an electronic Dispute Denial for Final Conditional Payment Case Letter with Current Conditional Payment Amount	Electronic Dispute Denial for Final Conditional Payment Letter Confirmation
View/Dispute Claims Listing	Claims Listing or Demand Claims Listing
View/Provide the Notice of Settlement Information	Settlement Information (until settlement information has been provided). View Settlement Information (when the MSPRP case status is equal to Demand, Demand in Progress, or Bill Issued; or the Final Conditional Payment Status = Complete).
Initiate Demand Letter	Initiate Demand Letter Confirmation
View/Submit Redetermination (First Level Appeal)	Redetermination not yet submitted: Warning - Confirm Request to Submit a Redetermination (First Level Appeal) Redetermination previously submitted on MSPRP: View Redetermination (First Level Appeal) Submission
Submit Waiver Request	Warning - Confirm Request to Submit a Waiver
Submit Compromise Request	Warning - Confirm Request to Submit a Compromise
Submit Case Documentation	Submit Case Documentation

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April 2025