Claims Dispute Confirmation Page

This page confirms that you have successfully submitted claims for dispute for the Case ID displayed at the top of the page. The Claim Control ID (ICN), Line Number, Total Charges, Reimbursed Amount, and Conditional Payment for each disputed claim are listed at the top of the page. The Case ID displayed will either be the Benefits Coordination & Recovery Center "BCRC Case ID" (BCRC insurer cases and beneficiary cases) or the Commercial Repayment Center "CRC Recovery ID" (CRC insurer cases).

Note: Certain information is masked unless you are the beneficiary, or you have logged in using Multi-Factor Authentication. The file names of any documentation submitted to support the contention will also be listed.

Click Print this page to make a copy of the disputed claims for your records.

Click Continue to return to the Case Information page.

Next Steps:

Please allow 45 days for the Centers for Medicare & Medicaid Services (CMS) to review the submitted dispute and make a determination. If CMS determines that the documentation provided at the time of the dispute is not sufficient, the dispute will be denied. You will receive a letter explaining Medicare's determination once the review is complete.

If Medicare disagrees with your dispute and determines that all of the claims submitted for dispute are related to the case:

• All claims submitted for dispute will remain on the Claims Listing page and the Dispute checkbox will be unchecked.
• The Current Conditional Payment Amount, Conditional Payment Updated On, and Conditional Payment Letter Mail Date will not be revised on the Medicare Secondary Payer Recovery Portal (MSPRP).

If Medicare agrees (fully or partially) with your dispute and determines that all (or some) of the claims submitted for dispute are not related to the case:

• All claims that Medicare has agreed are unrelated will be removed from the Claims Listing page.
• The Current Conditional Payment Amount will be updated.
• The Conditional Payment Updated On field will be revised to the date the Current Conditional Payment Amount was updated.
• The Conditional Payment Letter will be sent to all parties authorized on the case. (This letter will include the Current Conditional Payment Amount and a revised Payment Summary Form.
• The Conditional Payment Letter Mail Date will be updated to the date the Conditional Payment Letter was sent.