New Case Creation

This page allows you to enter information that will be used to evaluate whether or not a case may be created.

You may not create a new case if:

A case already exists (and the case has not yet expired);
The proposed settlement amount is under threshold (i.e., the settlement amount must be greater than $25,000 for beneficiaries or greater than $250,000 for non-beneficiaries); or
The beneficiary is deceased.

All fields are required. You can enter (and re-enter) either the beneficiary/claimant's Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]) or the Social Security Number (SSN). (Note: HICNs and SSNs are partially masked.) The Medicare ID is also known as the Medicare Number by CMS' Medicare beneficiaries.

Note: If you are creating a new case due to a required resubmission of an expired case, all fields except the Proposed Settlement Amount field will be pre-filled and read-only. A case has expired if it has remained in Closeout status (CLOS) for at least 12 months.

New Case Creation

Field	Description
Medicare ID	Enter the beneficiary/claimant's Medicare ID. Required if the claimant's SSN is not entered. Note: For Self-account types, the Medicare ID that was provided during initial registration will be pre-filled and not editable. For Corporate and Representative account types, the Medicare ID must be manually keyed.
Social Security Number (SSN)	Enter the beneficiary/claimant's social security number. Required if the claimant's Medicare ID is not entered. Note: For Self-account types, the SSN that was provided during initial registration will be pre-filled and not editable. For Corporate and Representative account types, the SSN must be manually keyed.
Re-Enter Medicare ID	Re-enter the beneficiary or claimant's Medicare ID. If you enter the Medicare ID, you cannot enter an SSN.
Re-Enter SSN	Re-enter the beneficiary or claimant's SSN. If you enter the SSN, you cannot enter a Medicare ID.
Initial Date of Injury	Date of first injury. If there are additional dates of injury for a single case, additional DOIs must be entered on the Case Notes page. If there are additional dates of injury for this beneficiary/claimant that are NOT associated with this case, a separate case or cases must be submitted.
Last Name	Enter the beneficiary/claimant's last name (Corporate and Representative accounts types). Note: For self-account types, Last Name was provided during initial registration and will be pre-filled and not editable.
First Name	Enter the beneficiary/claimant's first name (Corporate and Representative accounts types). Note: For self-account types, First Name was provided during initial registration and will be pre-filled and not editable.
Gender	Select the beneficiary/claimant's gender from the dropdown list (Corporate and Representative account types). Note: For self-account types, gender was provided during initial registration and will be pre-filled and not editable.
Date of Birth	Enter the claimant's birth date, in MM/DD/YYYY format (Corporate and Representative accounts types). Note: For self-account types, Date of Birth was provided during initial registration and will be pre-filled and not editable.
Proposed Settlement Amount	Enter the Proposed Settlement Amount for the case.

Click Continue to continue the new case creation process.

Click Cancel to cancel the case creation and return to the Home page. You can cancel out of the case creation process at any time (prior to case submission). Any information entered will be lost unless the case is submitted or saved as a Work In Progress.

How Beneficiaries are Validated

When you click Continue, the WCMSAP will attempt to match the information you enter to an existing Medicare beneficiary in the Medicare Beneficiary Database (MBD). There are three possibilities when attempting to match a beneficiary:

If a match is found, you will receive a message that a beneficiary match was found. The system will use stored demographic information about the beneficiary on the ensuing pages.
If a match is found, but some of the data you entered is incorrect, you will receive a warning page explaining that the system will use the information stored, rather than what you entered, to continue with the case creation process. The system will use the corrected demographic information about the beneficiary on the ensuing pages.
If a match is not found, the system will display a warning, and allow you to correct the information you entered, or continue to create the case anyway.

In all three scenarios, you may still create a new case. The following steps provide more details about beneficiary matching.

If a beneficiary match is found:

A page displays confirming that a Medicare beneficiary has been found that matches the information you entered. On this page, you can:

Click Continue to proceed with case creation and display the Beneficiary/Claimant information page.
Click Cancel to return to the Home page and cancel the case creation process. No data you entered will be saved unless you saved the case as a Work-In-Progress. In this case, only data you entered after saving will be lost.

Notes:

If you enter the Date of Birth (DOB) or Gender incorrectly, but the data you entered matches three out of four criteria (i.e., Medicare ID or SSN, First Name [first initial], Last Name [first six letters], and Gender), the WCMSAP will display a warning message confirming that the DOB or Gender from the beneficiary database will be used to create the case. On this warning page, click Continue to create the case with the corrected information, or click Cancel to return to the Home page and cancel the case creation process (no data will be saved unless you previously saved the case as a Work-In-Progress).
For self-accounts, the demographic information stored on file will be displayed as read-only on the ensuing pages of the case creation process.
For corporate and representative accounts, demographic information will be hidden on the following pages to protect the official beneficiary contact information.

If a beneficiary match is NOT found:

A warning page displays indicating that the beneficiary could not be matched based on the information you entered. On this page, you can:

Click Previous to return to the New Case Creation page. The information you entered will display, allowing you to make any edits necessary.
Click Continue to create the case anyway, and display the Beneficiary/Claimant information page.
Click Cancel to return to the Home page and cancel the case creation process. No data you entered will be saved unless you saved the case as a Work-In-Progress. In this case, only data you entered after saving will be lost.

Note: If the information cannot be matched, you may continue creating the case provided that the claimant is expected to become a Medicare beneficiary within the next 30 months (2 years and 6 months).

Next Steps

Once you create a case, you can continue adding case information, upload corresponding documentation in PDF file format, or save the case as a Work In Progress. A Work-In-Progress case allows you to enter part of the new case information and save it to the WCMSAP. The information saved will be available when you return to the portal to complete the new case creation process.

Helpful Links