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The Claims Disputed section displays the claims that you selected for dispute for the Case ID shown at the top of the page. The Claim Control ID (ICN), Line Number, Total Charges, Reimbursed Amount, and Conditional Payment will display for each claim. 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.
Verify this list to ensure that it only includes claims you believe are un-related to the case. To revise the list, click the Previous button to be returned to the Claims Listing page.
Final Conditional Payment Cases
If you have begun the Final Conditional Payment process for the BCRC Case ID shown at the top of the page, you can only dispute a claim or line item one time. However, once Medicare issues a final demand, you still maintain your rights to appeal. The demand letter will provide information on how to request an appeal if you disagree with the amount or existence of the debt.
Supporting Information & Documentation:
After you have verified that the only claims listed are those claims that are not related to the case, you must submit documentation (evidence) to support your contention. You can enter up to 500 characters of free-form text in the area in the middle of the Claims Dispute Verification page to explain the reason for your dispute.
If you are only entering free-form text and not uploading any additional supporting documentation, click the Continue button. The Claims Dispute Confirmation page will display where you must click its Continue button. Clicking Continue displays the Case Information page. The free-form text you entered will be added to the permanent case but will no longer be viewable on the Medicare Secondary Payer Recovery Portal (MSPRP).
If you require additional space to support your dispute, create a PDF file of your documentation and follow the instructions for uploading documentation found in the Documentation Upload help page. You are required to provide a brief description of the injury and explanation for any claims you disputed as unrelated to the case in the free form text area on this page or upload documentation that supports your dispute.
Note: If this is a Final Conditional Payment case, please provide complete and accurate supporting documentation at this time to ensure that your dispute is properly reviewed. Once the dispute is submitted, you will not have the option to submit additional documentation until after CMS issues its final demand.
Supporting Documentation Submission Guidelines:
To dispute what is being claimed or released with respect to the accident, injury, illness, or incident, follow these guidelines: For a List of documents that would assist you in processing your dispute request, click What Is This?
| Reason for Dispute | Supporting Documentation Required |
| General Health Conditions (e.g., flu, diabetes, etc.) | None |
| Claim is for a pre-existing condition | • Medical proof of the pre-existing condition; and • Documentation such as a court complaint that shows the condition isn't being pursued as part of the case (if available) |
| Claim date of service is after the beneficiary ended their accident, injury, illness, or incident-related treatment | Doctor's statement that includes the last date the beneficiary received treatment related to the accident, injury, illness, or incident |
| Claim is for accident, injury, illness, or incident not being pursued as part of the case (e.g., the case in question is related to the back and claim in dispute is related to the neck) | Medical proof and documentation such as a court complaint that shows this condition isn't being pursued as part of the case |
Note: If you are providing copies of the corresponding medical records, highlight or mark the pertinent areas of the records or documents which support your position.
Uploading Supporting Documentation
When you are ready to submit your supporting documentation on the MSPRP, click Upload Documentation. Once clicked, the Documentation Upload page will display. Follow the instructions for uploading documentation found in the Documentation Upload help page.
After you upload documents on the Documentation Upload page, click Continue to return to the Claims Dispute Verification page. If you entered free-form text, it will be displayed in the box in the middle of the page. The name of the documents that were uploaded will be displayed at the bottom of the page. Review the free-form text that was entered (if any). Ensure it is correct. It will not be viewable once the documentation upload process is complete. Also review the names of the documents that were submitted.
a. If an incorrect file was uploaded, click Delete. This will remove the file and it will not be uploaded to the case.
b. If there is a need to upload a different document, click the Upload Documentation and you will be returned to the Documentation Upload page.
To cancel the dispute process, click Cancel. Any uploaded documents or free-form text that was entered will be lost and you will be returned to your Case Information page.
To complete the submission of the dispute documentation, click Continue . The Claims Dispute Confirmation page will display.
Note: Please do not mail or fax any documentation that you have successfully uploaded to the MSPRP. This will slow down the review process.
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