This page provides you with the ability to enter and submit Notice of Settlement (NOS) information, and if the case qualifies for the Fixed Percentage Option, you can select that settlement option. When a beneficiary receives a settlement, judgment, award, or other payment, Medicare is entitled to recover associated payments made by the Medicare program. In order for Medicare to properly calculate the net refund due, settlement information must be provided.

You are recommended to submit your NOS Information as soon as the case has settled even if the settlement amount has not been received or if the funds are tied up in the registry of the courts.

Note: Submitting settlement information pertains only to beneficiary-debtor cases.

Do not submit Notice of Settlement Information in the following situations:

• The settlement amount is a "proposed" amount.
• Additional claims, not previously submitted for dispute, are now in dispute. In this case, click Previous to return to the Case Information page and select the View/Dispute Claims Listing action. Follow the instructions on that page to submit the claims for dispute.

Cases in Final Conditional Payment Process

If you have begun the Final Conditional Payment process and you have selected the Calculate Final Conditional Payment action, your conditional payment amount has been frozen.

This amount will remain your Final Conditional Payment Amount as long as:

• Your actual settlement date is within 3 business days of requesting your Final Conditional Payment Amount, and
• You submit notice of settlement information on the MSPRP within 30 calendar days of requesting your Final Conditional Payment Amount.

Table 1: Settlement Information Description

Field	Description
Injury Type	The type of accident/injury/illness being claimed and/or released with respect to the Medicare beneficiary. This field is required. Select: Traumatic Injury - An injury/illness resulting from a sudden physical injury such as a slip and fall, or auto-accident (i.e., the injury/illness does not relate to ingestion, exposure, or medical implant). Non-Physical Trauma-Based Injury - An injury/illness that does not result from a sudden physical injury (i.e., an alleged injury resulting from exposure, implantation, or ingestion of a substance.). Notes: Traumatic Injury must be selected when the Fixed Percentage Option is selected. If this case in in the Final Conditional Payment process and the Injury Type selected is a Non-Physical Trauma-Based injury, Medicare reserves the right to amend or modify the Final Conditional Payment Amount if additional claims related to the alleged injury resulting from exposure, implantation, or ingestion of a substance are later identified and were not included in the Final Conditional Payment Amount.
Settlement Amount	The dollar amount of the total payment obligation to or on behalf of the Medicare beneficiary in connection with the settlement, judgment, award or other payment. Note: If attorney fees and/or costs are awarded in addition to the settlement, please include the award as a part of the Settlement Amount. This field is required. Data Entry Requirements: Enter a numeric value (decimals and commas are optional. You can enter cents as well. If cents are not entered, the MSPRP will store the amount with zero cents. For example, a settlement amount of $10,000. Could be entered as: 10000; or 10,000; or 10,000.00). Do not enter the '$' as part of your entry. Must be less than or equal to $10,000 if the Fixed Percentage Option is selected. Must be greater than or equal to $0.01 (one cent).
Settlement Date	The date the payment obligation was established, not necessarily the payment date or check issue date. It is the date the obligation is signed if there is a written agreement unless court approval is required. If court approval is required it is the later of the date the obligation is signed or the date of court approval. If there is no written agreement it is the date the payment (or first payment if there will be multiple payments) is issued. This field is required. Data Entry Requirements: Must be a valid date. Date must be greater than 01/01/1960. Date must be less than or equal to the current date. Date must be greater than the Date of Incident on the case. Note: For cases in the Final Conditional Payment process: if the entered Settlement Date is not within 3 business days of the Final Conditional Payment Requested date, you will be asked to verify the Settlement Date. If the Settlement Date is not within 3 business days of the Final Conditional Payment Requested Date, the case will be voided from the Final Conditional Payment process.

Settlement Details

Select one of the four options: None, Attorney Fees, Attorney Fee Percentage or Fixed Percentage Option. If no option is selected, the settlement information will be processed without Attorney Fees.

Table 2: Settlement Details Section Description

Option	Description
None	Indicates that the beneficiary did not incur any attorney fees.
Attorney Fees	Indicates that the beneficiary incurred attorney fees. Use this selection when a dollar amount will be entered for the attorney fees and/or expenses. Important: Fees and costs are limited to what the beneficiary had to pay to attain the settlement. Only those costs borne by the beneficiary should be entered. If nothing is entered, this request will be processed without Attorney Fees. If the insurer/employer is entering settlement information for a workers' compensation case and the attorney fees and/or expenses were paid by the beneficiary: The MSPRP will prevent you from entering attorney fees and costs. Do not upload any settlement documentation on the MSPRP. If you need to submit attorney fees & expenses, you must submit this information in writing (mail/fax) to the following address/fax (For BCRC cases only): NGHP PO Box 138832 Oklahoma City, OK 73113 Fax: (405) 869-3309 Data Entry Requirements: Enter a numeric value (decimals and commas are optional. You can enter cents as well. If cents are not entered, the MSPRP will store the amount with zero cents. For example, a settlement amount of $10,000. Could be entered as: 10000; or 10,000; or 10,000.00). Do not enter the '$' as part of your entry. Must be greater than or equal to $0.01 (one cent). Attorney Fees and/or Attorney Expenses cannot both be zero. Attorney Fees: Total amount charged by the attorney to take the case. Attorney Expenses: Total amount of additional expenses (not including the Attorney Fees) charged by the attorney.
Attorney Fee Percentage	The agreed-upon percentage of the settlement amount charged by the attorney to the beneficiary. If the insurer/employer is entering settlement information for a workers' compensation case and the attorney fees and/or expenses were paid by the beneficiary: The MSPRP will prevent you from entering attorney fees and costs. Do not upload any settlement documentation on the MSPRP. If you need to submit attorney fees & expenses, you must submit this information in writing (mail/fax) to the following address/fax (for BCRC cases only): NGHP PO Box 138832 Oklahoma City, OK 73113 Fax: (405) 869-3309 Enter a whole number between 1 and 100 (Fractions or percentages are not allowed).
Fixed Percentage Option	An option that provides certain Medicare beneficiaries with an alternative to resolving Medicare's recovery claim. Case must meet specific criteria. For information on these requirements, please see the What is the Fixed Percentage Option help page.

Exclusions

MED/PIP/Other Exclusions: The total coverage amount paid directly to the Medicare beneficiary and/or Medicare from Medical Payments Coverage (MEDPAY), Personal Injury Protection (PIP) or another coverage with respect to the accident/injury/illness/incident being claimed and/or released. Note: If Medicare has paid claims in relation to the incident, Medicare's recovery amount will be directly impacted by the amount entered.

Data Entry Requirements:

• Cannot be entered if the Fixed Percentage Option has been selected.
• When entered, it must contain a numeric value (decimals and commas are allowed).

Attestation

A checkbox that indicates you are confirming the accuracy of the submitted settlement information. You must select this box in order to submit your settlement information.

Upload Supporting Documentation

Official Settlement Documentation (court documents) is not always required, follow the submission guidelines below.

Table 3: Uploading Supporting Documentation Guidelines

Settlement Details	Supporting Documentation Required
Fixed Percentage Option selected Note: The MSPRP will prompt you to upload the required document.	Document that includes the information in the model language document found at the following link: Fixed Percentage Option Election Model Language.
Settlement information exceeds the MSPRP threshold restrictions Note: The MSPRP will prompt you to submit a detailed breakdown of attorney fees and expenses when this occurs.	Final Settlement Detail Document that includes the: Amount of Settlement, Date of Settlement, Attorney's Fees paid by the beneficiary (if any), and An itemized list of Attorney Expenses paid by the beneficiary

Supporting Documentation Restrictions

• Submit settlement related documentation only. Any other documents submitted will not be reviewed.
• Do not submit a dispute as part of the settlement documentation.
• Do not mail or fax any documentation that you have successfully uploaded to the MSPRP. This will slow down the review process.

When you are ready to submit your supporting documentation, click Upload Documentation. Once clicked, the Documentation Upload page will display. Follow the instructions for uploading documentation found in the Upload Documentation help page.

After you have uploaded all required files on the Documentation Upload page, click Continue. You will be returned to the Settlement Information page. Verify that the correct files have been uploaded.

If an incorrect file has been uploaded, click Delete. This will remove the file and it will not be uploaded to the case.

To abandon the notice of settlement process, click Cancel. Any information entered, as well as any uploaded documents, will be lost and you will be returned to the Case Information page.

Click Print this Page to keep a copy of this information for your records.

Click Continue once you have confirmed that all uploaded files should be submitted for the case. This will complete the submission process. Note: If you are not uploading any supporting documentation, you must click Continue to submit your Notice of Settlement. Once Continue is clicked, the Notice of Settlement Confirmation page will display.

Next Steps

Please allow 20 days for CMS to review the supporting documentation and send the Final Demand Letter. Follow the instructions provided in the letter you receive to avoid any penalties.

October 2023