This option allows you to request an Electronic Conditional Payment Letter (eCPL). Beneficiaries, or their representatives with a verified Proof of Representation (POR) who log in using multi-factor authentication, can request an eCPL for either a Benefits Coordination & Recovery Center (BCRC) or Commercial Repayment Center (CRC) case, as long as the case meets certain criteria (see "Case Criteria").

Insurers, recovery agents who were submitted on the insurers' Tax Identification Number (TIN) reference file, and insurer representatives with a verified Recovery Agent Authorization, who log in using multi-factor authentication, can also request an eCPL for insurer-debtor cases only.

About the Electronic Conditional Payment Letter

This letter identifies Medicare's current conditional payment amount (as noted in the Current Conditional Payment Amount on the Case Information page) for the case. The eCPL will include a Payment Summary Form listing claims paid by Medicare that are being claimed and/or released with respect to the accident, illness, injury, or other incident. For more information on the conditional payment amount see the Request an update to the conditional payment amount help page.

Cases in Final Conditional Payment Process

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.

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, Status is not Active, Pending NOS, or Complete), an Electronic No Claims Paid by Medicare letter is generated. A Payment Summary Form is not displayed with this letter.

You can see an example of the Payment Summary Form field description by clicking the MSPRP User Guide link located under the Reference Materials menu.

Case Criteria:

The ability to request an electronic conditional payment letter is available to beneficiaries for either BCRC or CRC cases. This option is also visible and active for authorized beneficiary representatives who have a POR signed by the beneficiary in verified status and who log in using multi-factor authentication. Insurers and their authorized representatives who have a verified Recovery Agent Authorization, who log in using multi-factor authentication, can also request an eCPL for insurer-debtor cases only.

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):
  • 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.

Note: 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.

When you select the Request an electronic conditional payment letter with Current Conditional Payment Amount action, the MSPRP will generate the electronic conditional payment letter in a separate browser window, along with the Payment Summary Form in .PDF format. A confirmation page is displayed afterwards indicating that you have successfully requested the generation of the electronic conditional payment letter. Once displayed, you will see options to save or print the letter to a local machine or printer. Clicking the Continue button on the confirmation page will return you to the Case Information page.

Notes:

When requested, the eCPL always contains current conditional payment and claims information. However, if the Current Conditional Payment Amount equals zero ($0.00), then no Payment Summary Form is displayed.

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.

The Request an electronic conditional payment letter with Current Conditional Payment Amount action will not update the Current Conditional Payment Amount prior to the letter being generated. However, claims are retrieved daily, so the Conditional Payment Amount displayed on the Case Information page will be up to date as of the previous day.

There may be times when new claims still need to be added to the amount. In this case, if you require an updated conditional payment amount prior to generating an electronic conditional payment letter you must do the following:

1. Go to the Case Information page.
2. Select Request an update to the conditional payment amount. Wait until the Current Conditional Payment Amount on the Case Information page has been updated.
3. Return to the Case Information page.
4. When the Case Status has changed from Claim Retrieval back to Open, and the above conditions have been met, select the Request an electronic conditional payment letter with Current Conditional Payment Amount option.