Print this page Print this page | Close
Request an Update to the Conditional Payment Amount

This option allows you to request an update to the Conditional Payment Amount for either a Benefits Coordination & Recovery (BCRC) or Commercial Repayment Center (CRC) case.

About the Conditional Payment Amount

Under the Medicare Secondary Payer (MSP) laws (42 U.S.C. 1395y(b)), Medicare does not pay for items or services to the extent that payment has been, or may reasonably be expected to be, made through a no-fault or liability insurer or through workers' compensation. Medicare may pay for services on behalf of a Medicare beneficiary when there is evidence that the primary plan does not pay promptly. These payments are referred to as conditional payments because the money must be repaid to Medicare when a settlement, judgment, award, or other payment is secured.

Once Medicare has information concerning a potential recovery situation, it will identify the conditional payments related to the case from the date of incident through the date of settlement, judgment, award, or other payment.

Clicking this action directs the MSPRP to display all new, related medical claims that have been paid subsequent to the date indicated in the Conditional Payment Amount Updated on field and calculate the current conditional payment amount.

Request Conditions

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. For BCRC and CRC cases, any user may request an update. No authorization is required.

About the Claims Retrieval Process

Claims are retrieved daily and will be up-to-date as of the previous day. The MSPRP displays claims information for your case on the Case Information page. The current conditional payment amount is displayed in the Conditional Payment Amount Updated field, and the date the payment was last updated is displayed in the Conditional Payment Calculation Date field.

If all the claims are not up to date at the time you make this request, based on the date shown in the Conditional Payment Amount Updated field, continue with the request but please allow 3-5 days for the system to process the update to the conditional payment amount. While the request is being processed, the Case Information page will be updated as noted below. These updates will not occur immediately.

If there are no new paid claims, the Case Information page will be updated as follows:

Case Status No change. Case Status will remain Open.
Current Conditional Payment Amount No change.
Conditional Payment Amount Updated On Revised to reflect the date the request for the updated Conditional Payment Amount was made.

If there are new paid claims, Medicare will review them to determine if they are related to the case.

  • During the claim retrieval/review process, the Case Information page will be updated as follows:
    Case Status Changed to Claims Retrieval.
    Current Conditional Payment Amount May fluctuate. The true updated conditional payment amount will not be displayed until the Case Status has changed back to Open.
    Conditional Payment Amount Updated On May fluctuate. The true date will not be displayed until the Case Status has changed back to Open.
  • After the retrieval/review process is complete, the Case Information page will be updated as follows:
    Case Status Changed to Open.
    Current Conditional Payment Amount Revised to include all new, related conditional payment amounts through the date reflected in the Conditional Payment Amount updated on field.
    Conditional Payment Amount Updated On Revised to reflect the date the Current Conditional Payment Amount was updated.

Next Steps

You must request an update to the conditional payment amount when the case has settled and you are ready to submit settlement information. The conditional payment amount must be updated within 10 calendar days of submitting Notice of Settlement information through the portal.