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What is Recovery Agent Authorization?

You can submit an Recovery Agent Authorization request to inform the Centers for Medicare & Medicaid Services (CMS) that an applicable plan (such as a self-insured, no-fault insurer or workers' compensation entity) wishes to be 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 appropriate authorization documentation on file.

Recovery Agents who are associated to an insurer-debtor case as the insurer's Section 111 (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.

A person with a verified Recovery Agent Authorization can perform the following actions on the Case Information page for Commercial Repayment Center (CRC) and Benefits Coordination & Recovery Center (BCRC) insurer-debtor cases:

BCRC Cases

  • View/Request Authorizations
  • View Case Data
  • View/Dispute Claims Listing
  • Request an update to the conditional payment amount
  • Request a (mailed) copy of the conditional payment letter
  • Request an electronic copy of the Conditional Payment Letter (eCPL) (for beneficiaries and insurer representatives who log in using multi-factor authorization) (insurer-debtor cases)
  • Initiate Demand Letter
  • View/Submit redetermination request
  • Initiate Final Conditional Payment

CRC Cases

  • View/Request Authorizations
  • View case data
  • View/Dispute Claims Listing
  • Request an update to the conditional payment amount
  • Request a (mailed) copy of the conditional payment letter
  • Request an electronic copy of the Conditional Payment Letter (eCPL) (for beneficiaries and insurer representatives who log in using multi-factor authorization)
  • Initiate Demand Letter
  • View/Submit redetermination request
  • Initiate Final Conditional Payment

A person with a verified Recovery Agent Authorization cannot perform the following actions on the Case Information page:

CRC Cases

  • Provide Notice of Settlement (NOS) information