Case Creation Continued

This page allows you to finish the case reporting process once information submitted on the Case Creation page has been validated. Use this page to view the validated case details and to enter and edit diagnosis codes related to the accident/incident. You must include at least one diagnosis code.

Field	Description
Beneficiary Medicare ID	The beneficiary's Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]). Read-only.
Beneficiary Last Name	The beneficiary's last name. Read-only.
Beneficiary Date of Birth	The beneficiary's date of birth. Read-only.
Date of Accident/Incident	The date of accident or incident. Read-only.
Insurance Type	The insurance type (Liability (including self-insurance) or Workers' Compensation). Read-only.
DX Code Search	Click this button to open the Diagnosis Code Search Criteria page and begin the process of searching for diagnosis codes to add. Note: Once a diagnosis code is selected and added, it will appear in the diagnosis code table
Injury Category DX Code Search	Click this button to open the Diagnosis Code Selection by Injury Category page and begin the process of searching for diagnosis codes to add. Note: You may search for diagnosis codes by injury category, view a list of available diagnosis codes, add a list of selected diagnosis codes, and add diagnosis codes on the Diagnosis Code Search Criteria page.Once a diagnosis code is selected and added, it will appear in the diagnosis code table.
Related Diagnosis (DX) Code(s)	Enter a diagnosis code related to the accident/incident. Notes: You may only enter one diagnosis code at a time. To prevent inaccurate case creations and recoveries, the MSPRP will only accept reports that are related to physical trauma. If your case is not related to physical trauma, it requires additional review and must be submitted via mail or fax.
DX Ind	Select the ICD indicator (ICD-9 or ICD-10). Note: If the Date of Accident/Incident is on or after 10/1/2015, the DX Ind field will automatically be set to ICD-10 and cannot be updated. If this date is before 10/1/15, you must manually select the ICD indicator for the related diagnosis code.
Add DX Code	Click this button to add the diagnosis code to the case. Note: You must enter at least one diagnosis code. You must select an ICD indicator before you can add the diagnosis code. If your diagnosis code and ICD indicator are valid, the diagnosis code will appear in the diagnosis code table.
Total Codes Selected:	Displays the total number of codes attached to the record.
Diagnosis Code Table	A list of all diagnosis codes related to the accident/incident.
Delete	Click the "X" to delete any diagnosis code that was added to the record.
DX Code	The diagnosis code added to the record.
DX Ind	The ICD indicator for the corresponding diagnosis code (ICD-9 or ICD-10).
Description	The description for the corresponding diagnosis code.

Click Continue to submit the case to CMS.

Note: To prevent inaccurate case creations and recoveries, the MSPRP will only accept reports that are related to physical trauma. If your case is not related to physical trauma, it requires additional review and must be submitted via mail or fax to:

Special Projects

PO Box 138868

Oklahoma City, OK 73113

Fax #: (833)-844-1540

Note:To report a no-fault case, contact the BCRC by phone at 855-798-2627 or by mail at:

NGHP

PO Box 138832

Oklahoma City, OK 73113

Click Cancel to cancel the case submission process and return to the Welcome! page (beneficiaries) or Account List page (non-beneficiaries).

April 2025