An official website of the United States government
The WCMSA Administrator page allows you to identify the WCMSA case account administrator. Administrator information is required before you will be able to submit a case.
The administrator type selected determines the type of administrator information that is captured during the case creation process. The default option is "Self." The other administrator types are Rep Payee and Professional Administrator.
Note: When "Professional Administrator" is selected as the administrator type, you will be required to upload a document to the 30- Set-Aside Administrator or Copy of Agreement category on the Case Documents page before you will be allowed to submit this case.
Table 1: Administrator Types
| Type | Description |
|---|---|
| Professional Administrator | A professional corporate entity who is administering the WCMSA account. Note: When selected, a copy of the Professional Administrator Agreement is required before you can submit a case. You can upload this document on the WCMSAP Documents tab. |
| Rep Payee | A non-corporate entity who is administering the WCMSA account on behalf of a beneficiary. |
| Self | A Medicare beneficiary who is administering the WCMSA account on their own behalf. |
Table 2: Professional Administrator
| Field | Description |
|---|---|
| Name | Enter the company name of the individual or entity responsible for administering the WCMSA account. Required. |
| Employer Identification Number | Enter the EIN of the individual or entity responsible for administering the WCMSA account. Required. |
| Address Line 1 | Enter the first line of the mailing address of the individual or entity responsible for administering the WCMSA account. Required. |
| Address Line 2 | Enter the second line of the mailing address of the individual or entity responsible for administering the WCMSA account. Otherwise, displays as blank. |
| City | Enter the city of the individual or entity responsible for administering the WCMSA account. Required. |
| State | Select the state of the individual or entity responsible for administering the WCMSA account from the drop-down menu. Required. |
| Zip Code | Enter the 5-digit ZIP code of the individual or entity responsible for administering the WCMSA account (Required) and 4-digit extension (Optional). |
| Phone | Enter the phone number of the individual or entity responsible for administering the WCMSA account, including the area code. Required. |
| Fax | Enter the fax number of the individual or entity responsible for administering the WCMSA account. Otherwise, displays as blank. |
| E-mail Address | Enter the email address of the individual or entity responsible for administering the WCMSA account. Otherwise, displays as blank. |
| Re-Enter E-Mail Address | Re-enter the email address to validate (if email entered). |
Table 3: Rep Payee
| Field | Description |
|---|---|
| Name | Enter the first and last name of the representative payee for the beneficiary associated to this account. Required. |
| Address Line 1 | Enter the first line of the representative payee’s mailing address. Required. |
| Address Line 2 | Enter the second line of the representative payee’s mailing address. Optional. |
| City | Enter the representative payee’s city. Required. |
| State | Select the representative payee’s state from the drop-down menu. Required. |
| Zip Code | Enter the representative payee’s 5-digit ZIP code (Required) and 4-digit extension (Optional). |
| Phone | Enter the representative payee’s phone number, including the area code. Required. |
| Fax | Enter the representative payee’s fax number. Optional. |
| E-mail Address | Enter the representative payee’s email address. Required. |
| Re-Enter E-Mail Address | Re-enter the representative payee’s email address to validate. Required. |
Table 4: Self
| Field | Description |
|---|---|
| Name | Displays the first and last name of the beneficiary associated to this account. This field is pre-filled with the first and last name of the beneficiary. |
| Address Line 1 | Displays the first line of the beneficiary’s mailing address. This field is pre-filled with currently available information related to the beneficiary. |
| Address Line 2 | Displays the second line of the beneficiary’s mailing address. This field is pre-filled with currently available information related to the beneficiary, if available. Otherwise, displays as blank. |
| City | Displays the beneficiary’s city. This field is pre-filled with currently available information related to the beneficiary. |
| State | Displays the beneficiary’s state. This field is pre-filled with currently available information related to the beneficiary. |
| Zip Code | Displays the beneficiary’s ZIP code. This field is pre-filled with currently available information related to the beneficiary. |
| Phone | Displays the beneficiary’s phone number. This field is pre-filled with currently available information related to the beneficiary, if available. Otherwise, displays as blank. |
| E-mail Address | Displays the beneficiary’s email address. This field is pre-filled with currently available information related to the beneficiary, if available. Otherwise, displays as blank. |
Click the Previous button to return to the previous page.
Click Next to save all information entered up to this point and proceed to the next registration step.
Click Save Work-In-Progress to save all information entered up to this point. You can return to the WCMSAP later to complete the case creation process.
Click Case Summary to view a synopsis of the case information entered. Note: This is for new cases and cases in Work-In-Progress (WIP) status.
If all required fields and/or documents have been completed, click Submit Case from the Summary tab on the Case Summary page. Otherwise, a message appears indicating the missing fields or documents.
Click Cancel Case Creation to delete all entered information and cancel the case creation process.
A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services.
7500 Security Boulevard, Baltimore, MD 21244