The Medicare Secondary Payer Recovery Portal (MSPRP) allows you to view and/or dispute claim information that is currently associated to a Benefits Coordination & Recovery (BCRC) or Commercial Repayment Center (CRC) case through the use of the View/Dispute Claims Listing action.

The View/Dispute Claims Listing action can only be selected when:

• Case Status is:
  • Open and Active, or
  • Demanded, or
  • Complete or Pending NOS if the case is in Final Conditional Payment process (BCRC cases), and
• User is the case-debtor or has an authorization type of Beneficiary POR, Beneficiary CTR, or Recovery Agent Authorization, or is the recovery agent associated with the debtor, and
• Current Conditional Payment Amount is greater than zero ($0.00).
• A CPN or CPL has been issued (i.e., recovery has been initiated).

Note: While users with CTR authorization can click the View/Dispute Claims Listing action to view claims on the Claims Listing page, they cannot dispute claims on behalf of beneficiaries.

During your review process, if you identify claims that are not related to the case, you can submit them for dispute. Disputing a claim means that you are requesting the Centers for Medicare & Medicaid Services to remove the claim from the Current Conditional Payment Amount because it is not related to what is being claimed and/or released with respect to the accident, injury, illness, or incident. When you select a claim for dispute, you must provide an explanation to support your reasons for dispute. Please click the MSPRP User Guide under the Reference Materials menu on the MSPRP navigation bar for information and guidelines on what you should include in your supporting documentation.

Prior to a demand being sent, you may send an unlimited number of disputes for a BCRC or CRC case as long as it meets the above conditions. Each dispute may contain multiple claims.

Pre-Demand vs. Post-Demand

After a conditional payment notice (CPN) or conditional payment letter (CPL) has been issued for a case, but prior to that case being demanded, when you click View/Dispute Claims Listing, the MSPRP retrieves all claim information that is included in the Current Conditional Payment Amount and display that information on the Claims Listing page. The retrieval of this information may be slightly delayed depending on the volume of claim information returned. After the Claims Listing page displays, you can review all claims associated to the case.

Note: The Claims Listing page will continue to display all claims that are included with your submitted dispute even after the dispute is denied. However, the claims for accepted or approved disputes will no longer be associated with the case and will, therefore, no longer be displayed.

After a case has been demanded, or if a case has completed or is pending notice of settlement in the Final Conditional Payment process, clicking View/Dispute Claims Listing redirects you to the Demand Claims Listing page instead of the Claims Listing page. This read-only page displays information regarding the demanded claims for the selected case, such as the date the Demand letter was sent and the Demand Amount (or amount the debtor is required to pay Medicare). (Click the help link on the Demand Claims Listing page for further details.)

Once a case is demanded, you cannot dispute any claims. You may, however, continue to view all claims.

April 2022