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Benefits Coordination and

Recovery Center (BCRC)

Overview

Agenda• BCRC Responsibilities• BCRC Processes

– Overview of Data Collection process– Overview of Recovery process

• Medicare Secondary Payer Recovery Portal (MSPRP) Overview• BCRC Contact Information• Call Center

– IVR Tips– Virtual Hold

• Benefits of BCRC• Questions

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BCRC Responsibilities

• Determining who pays Medicare claims first

• Ensuring claims are paid correctly

• Sharing Medicare eligibility data with other primary payers

• Avoiding duplicate payments

• Sending claims data to other insurers

• Recover conditional payments or mistaken benefit payments

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How it works

BCRC

Recovery CenterData Collection

Collects information from multiple sources to research MSP situation.

• Section 111 Mandatory Insurer Reporting and Data Sharing Agreements (DSAs)

• Self Report (phone or portal)

• Workers Compensation Set-Asides

Responsible for identifying and recovering Medicare conditional and mistaken payments that should have been paid by another entity as the primary payer

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Overview of the Data Collection (DC)

Process

How Does BCRC Collect Information?

• Self Report (Call, Fax, Mail)– Attorney, Beneficiary, Insurer, Provider, etc.

• Data Sharing Agreements (DSA)– DSA – Data Sharing Agreement

• Mandatory Insurance Reporting (Section 111)• Group Health Plan (GHP)

• Non-Group Health Plan (NGHP) - No-Fault (NF), Workers’ Compensation (WC), and Liability

• Electronic Correspondence Referral System (ECRS)• MSP and Prescription Drug Assistance Requests

• MSP and Prescription Drug Inquiries

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Insurers, Beneficiaries, Providers or

Attorneys report a GHP, NGHP or

request information on Coordination

of Benefits (COB)

BCRC asks probing questions or

sends a development letter to

determine if the beneficiary’s

MSP record is accurate

Overview of the DC Process

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Option 1 - Reporting new GHP record

BCRC collects information

by completing an MSP

development questionnaire

In 48 hours systems

are updated

MSP confirmation letter is

sent to beneficiary


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BCRC collects information

by completing an MSP

development questionnaire

In 48 hours systems

are updated

MSP confirmation letter

is sent to beneficiary

Overview of the DC ProcessOption 2 - Reporting new NGHP record

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Option 2 - Reporting new NGHP record

System receives

electronic information

and creates a Lead

System forwards all NF and WC leads to the

Commercial Repayment Center (CRC)


System forwards all Liability leads to the BCRC

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Overview of the Recovery

Process

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Accident/incident/

illness occurs

Beneficiary goes to

hospital/doctor

Hospital/doctor

submits claim for

payment

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Recovery Process

Medicare makes

conditional payments

for services

Case is reported to

BCRC and information

is gathered

Rights and

Responsibilities (RAR)

Letter is issued

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The payment is “conditional” because it must be

repaid to Medicare if/when a settlement, judgment, award or other payment is secured

Recovery Process

The search for

Medicare

Claims begins

Medical claims related to the

incident are identified and a

Conditional Payment Letter

(CPL) is issued

Claims may be

disputed from the CPL if

recipient feels they are not

accident related

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Recovery Process

• Settlement, judgment, award, or

other payment is reached

• Notice of Settlement must be

submitted to the BCRC

The final conditional payment

amount is identified and a

Demand Letter is sent

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Recovery Process

Option 1 - Payment

A check is received for

demand amountMSP Recovery

Case Complete

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Recovery Process

Option 2 – Issues Arise

A post demand inquiry is sent.

(e.g. questions, appeals,

request for waiver, etc.)

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Recovery Process

• Appeal – disagreement with the

existence of the full/partial

overpayment amount

• Waiver – request for the entire

overpayment amount to be

forgiven

• Compromise – request for a

partial amount of the

overpayment to be forgiven

Interest is assessed if

the debt is not

resolved within 60

days from date of

demand

If full repayment is not

received within 60 days

from date of demand, an

Intent to Refer Letter (ITR)

is issued

If full repayment is not

received within 60 days of ITR

Letter (120 days of demand),

debt is referred to Treasury

once any outstanding

correspondence is worked

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Option 3 – Intent To Refer

Recovery Process

Medicare Secondary Payer Recovery Portal (MSPRP) High level Overview

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Case Access

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Request Case Access

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Bene Debtor vs. Insurer Debtor

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Bene Debtor Insurer Debtor

CMS is pursuing recovery from the beneficiary

CMS is pursuing recovery from an insurer

Case ID begins with a 2 Case ID begins with a 3*

BCRC sends correspondence• Beneficiary is the primary recipient• Authorized parties receive carbon

copies

CRC* sends correspondence• Insurer is the primary recipient• Beneficiary and any authorized parties

receive carbon copies

Beneficiary and those authorized by the beneficiary can take action on the case

Insurer and those authorized by the insurer can take action on the case

Report a Case

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Case Information

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Case Actions

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Contact Information

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Area Number

BCRC Call Center 855-798-2627

TTY Number 855-797-2627

Data Collection and Authorizations Fax Line

405-869-3308

Recovery Documents FaxLine

405-869-3309

Workers CompensationSet-Aside (WCSA) Fax Line

405-869-3306

MSP Data Collection Fax Line

405-869-3307

EDI Hotline 646-458-6740

Medicare Commercial Repayment Center (CRC)

NGHP – No-Fault & Workers Comp

Commercial Repayment Center- NGHPPO Box 269003Oklahoma City OK, 73126NGHP Fax Line- 844-315-7627

GHP

Commercial Repayment Center- GHPPO Box 248909Oklahoma City, OK, 73124GHP Fax Line- 844-315-4313

Contact Information

BCRC Area Address

MSP Data Collection

Data Collection Authorization

Data Collections AuthorizationsPO Box 138898Oklahoma City, OK 73113

Medicare MSP General Correspondence

Medicare-MSP General CorrespondencePO Box 138897Oklahoma City, OK 73113

Medicare MSP Claims Investigation Project

Medicare-MSP Claims Investigation ProjectPO Box 138897Oklahoma City, OK 73113

Data Sharing AgreementDSA ProgramPO Box 138897Oklahoma City, OK 73113

Workers Compensation Set-Aside Arrangement Proposal

WCMSA Proposal/Final StatementPO Box 138899Oklahoma City, OK 73113

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Contact Information

BCRC Area Address

Recovery

NGHP Inquiries/Checks/Recovery AuthorizationsNGHPPO Box 138832Oklahoma City, OK 73113

Fixed Percent OptionFixed Percent OptionPO Box 138880Oklahoma City, OK 73113

Special Projects (Product Liability Case inquiries and SP Checks)

Special ProjectsPO Box 138868Oklahoma City, OK 73116

Self Calculated Conditional Payment OptionSelf-Calculated Conditional PaymentPO Box 138880Oklahoma City, OK 73113

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IVR Tips

• 855-798-2627

• First Menu– Beneficiary- Press 1

– Calling about Beneficiary- Press 2

– Commercial Repayment Center- Press 4

– Selection must be made at this menu before pressing “0” for an agent

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IVR Tips• Beneficiary Menu

– 800 Medicare transfer- Press 1– Otherwise Press 2 for BCRC

• Complete Authentication via speech recognition (4 pieces)– Medicare Beneficiary Identifier (MBI) can be captured here with speech– If Social Security Number is used the, the 4th piece will be Entitlement Date

• Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on Beneficiary File

• Unsuccessful Authentication– Call is transferred to an agent

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IVR Tips

• Other Caller Menu– Provider- Press 1

– RRE- Press 2

– Attorney- Press 3

– Agent, Other Rep- Press 4

– Employer- Press 5

– DSA- Press 642

IVR Tips

• Authentication will vary based on caller type– Provider/RRE/DSA

• 2 pieces to identify entity• 2 pieces for Beneficiary

– Speech has been added to the Medicare prompt to collect the Medicare Beneficiary Identifier (MBI)

• Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on Beneficiary

File

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IVR Tips

• Authentication (continued)– Attorney/Third Party Administrator (TPA)/Other

Representative • 4 pieces for Beneficiary

– Speech has been added to the Medicare prompt to collect the MBI

– Unsuccessful Authentication– Call is transferred to an agent

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Self Service Information• Coverage Status

– Medicare Primary Versus Secondary– Status on Specific Date

• Entitlement Information– Date– Reason

• ESRD Information– Date of Dialysis– Coordination Period

• Recovery Information– RAR Date– CPL Mail Date and Amount– Demand Mail Date and Amount

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Virtual Hold

• Call Center offers Virtual Hold

– Offers to call back while holding place in the queue

– Once called back, agent is ready to assist

– Saves time by not waiting on hold

– Enhances customer experience

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How BCRC Benefits our Customers

• Enhanced Beneficiary experience because claims are processed with greater efficiency due to accurate records

• More timely processing of beneficiaries’ medical claims reduces employers administrative expenses

• Reduces cost of recouping payments made in error and ensures integrity of Medicare Trust Fund

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Questions?

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