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Claims Listing [Beneficiary or MFA]

This page lists each payment Medicare has made for an item or service associated to the case and provides you with the ability to dispute any un-related claims.

"The Case ID displayed will either be the Benefits Coordination & Recovery Center "BCRC Case ID" (BCRC insurer cases and all beneficiary cases) or the Commercial Repayment Center "CRC Recovery ID" (CRC insurer cases ).

The following claim information that is currently associated to the Case ID is displayed under the Claims heading on the bottom half of this page:

To select or deselect all claims on the page for the purpose of submitting a dispute, click the Select/Deselect hyperlink at the end of the list. Only those claims available for dispute will be selected. Claims that have been disputed and are currently under review, or claims disputed for a Final Conditional Payment case that were denied, cannot be selected.

Reported Diagnosis Codes

Displays a summary of the diagnosis codes reported on the case.

Claims Listing Fields

Field Description
Clear Click this button to remove any sorting or filtering and restore the default display of claims information.
Export Click this button to export the listed claims shown to a spreadsheet on your computer.
Dispute Checkbox that indicates whether the claim is or is not being disputed. There are three statuses:
  • Blank - indicates the claim is selectable. It can be disputed by clicking the box.
  • Faded checkmark - indicates the claim is not selectable. It has been previously selected for dispute and is currently under review, or was selected for dispute for a Final Conditional Payment case and has been denied, and cannot be disputed again.
  • Blank (Protected) - indicates the claim has not been disputed but the claim is not available because of the user's authorization level.

    • For BCRC Cases

    Who can view claims? Beneficiaries, case debtors, or users with verified Beneficiary Proof of Representation (POR), Beneficiary Consent to Release (CTR), or Recovery Agent Authorization.

    Who can dispute claims? Users must be the case beneficiary, the case debtor, or have verified Beneficiary POR or a Recovery Agent Authorization.

    For CRC Cases

    Who can view claims? Case beneficiaries, users with verified Beneficiary POR or Beneficiary CTR, case debtors (insurers) and insurer representatives with a verified Recovery Agent Authorization.

    Who can dispute claims? Users must be an insurer debtor or an authorized insurer representative with a verified Recovery Agent Authorization. Beneficiaries, or their representatives, cannot dispute claims.
TOS A two-digit identifier that represents the type of service received for the line item on the claim. It can be any of the following:
  • 10 - Home Health Agency
  • 20 - Skilled Nursing Facility (SNF) Non-swing
  • 30 - SNF Swing
  • 40 - Outpatient
  • 41 - Outpatient Full Encounter
  • 42 - Outpatient Abbreviated Encounter
  • 50 - Hospice
  • 60 - Inpatient
  • 61 - Inpatient Full Encounter
  • 62 - Inpatient Abbreviated Encounter
  • 71 - Carrier
  • 72 - Carrier Durable Medical Equipment Prosthetics/Orthotics & Supplies (DMEPOS) Claim);
  • 73 - Carrier Full Encounter Claim
  • 81 - Durable Medical Equipment Regional Carriers (DMERC) Non-DMEPOS
  • 82 - DMERC DMEPOS
Claim Control ID (ICN) Claim Number(Internal Control Number) assigned to the claim by the Medicare processing contractor. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; type in the text box to show only claims containing the entered text.
Line Reference to the individual service rendered on the claim.
Processing Contractor Identification number for the Medicare contractor that processed the claim.
Provider Name Name of the institutional or individual provider that submitted the claim for the service. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; type in the text box to show only claims containing the entered text.
Diagnosis Codes The ICD indicator and diagnosis code(s) for each listed claim. A diagnosis code represents the reason for the office visit or medical test. (Example format: ICD-10: E11.9, R51)

The diagnosis codes used by Medicare are known as ICD-9 or ICD-10 (ICD-9-CM or ICD-10-CM) codes (i.e., International Classification of Diseases 9th or 10th Revision, Clinically Modified). If you need assistance in understanding these codes, go to the following links:

https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes for a list of valid ICD-9 diagnosis codes.

https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS for more information regarding ICD-10 diagnosis codes.

Note: Hover over the field to view a description.
DRG Cd The three-digit Diagnosis Related Group codes for the Part-A Claims.
Note: Hover over the field to view a description.
CPT/HCPCS The five-character Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes for the Part-B Claims.
Note: Hover over the field to view a description.
From Date The start date of service for the claim. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; click the drop-down menu at the top of the column to show only claims in the selected date range.
To Date The end date of service for the claim. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; click the drop-down menu at the top of the column to show only claims in the selected date range.
Total Charges Amount billed by the provider. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; type in the text box to show only claims containing the entered text.
Reimbursed Amount Amount Medicare paid the provider.
Conditional Payment Amount due Medicare.
Dispute Submitted Date The (most recent) date the dispute was submitted on a case. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; click the drop-down menu at the top of the column to show only claims in the selected date range.
Note: The field will remain blank for any disputes submitted prior to the implementation of this feature.
Dispute Decision Date The (most recent) date for the dispute decision. Sortable and filterable column: click the arrows in the header to sort or reverse sort order; click the drop-down menu at the top of the column to show only claims in the selected date range.
Note: The field will remain blank for any disputes submitted prior to the implementation of this feature.

To assist you in correctly identifying a claim for dispute, it is recommended that you have your Payment Summary Form in hand. Your Payment Summary Form will have more comprehensive information than what is displayed on this page and will assist you in identifying and matching the claim information that should be included or disputed on the Medicare Secondary Payer Recovery Portal (MSPRP).

The claim information will be listed in the same order as the Payment Summary Form that is mailed with the Conditional Payment letter. You can see an example of the Payment Summary Form and field descriptions by clicking on the MSPRP User Guide under the Reference Materials menu.

The claims displayed on the Claims Listing page may differ from those listed on your Payment Summary Form if there has been any recent case activity between the date of the form and the current date. For example, information may have been removed as a result of a dispute or added as a result of new claims being associated to the case.

Notes:

  • If a claim was disputed and the dispute was approved, the claim will automatically be removed from the Claims Listing page.
  • Review each claim (the dates of service [From and To Dates], the rendering physician [Provider Name] and the diagnosis codes) and determine if it is related to what is being claimed or released with respect to the accident, illness, injury, or other incident.
  • Copyright: CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS (Federal Acquisition Regulation/Defense Federal Acquisition Regulation Supplement) Restrictions Apply to Government Use.

Claim Information Updates

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 Current Conditional Payment Amount field.

Dispute Unrelated Charges

To dispute the inclusion of a claim that is unrelated to your case, click the Dispute checkbox next to the claims(s) in dispute. You may only dispute a claim one time if the case is in the Final Conditional Payment process.

Note: If the Dispute checkbox contains a faded checkmark, this indicates the claim has been previously selected for dispute and is currently under review. Once all disputed claims are selected, click Continue to proceed to the Claims Dispute Verification page where you must confirm the claim(s) selected for dispute

Click Print this page to print a copy of this page for your records.

Click Cancel to return to the Welcome! page and forego the dispute process at this time. None of your claim dispute selections will be saved.

January 2024