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The WCMSA Account Balance and Attestation Submission page allows authorized users to view summary information about their WCMSA, view attestations previously submitted on the WCMSAP, upload and submit settlement documentation, and submit an annual attestation for all eligible cases.
Notes: The information displayed on this page and options available to you will vary depending on your role (whether or not you are the administrator of the WCMSA ) and whether final settlement documentation has been received and verified.
Every year, no later than 30 days after the end of each reporting year, which starts with the date the account is established and ends on that date in the following year, the administrator of the WCMSA funds must send an attestation to Medicare's Benefits Coordination & Recovery Center (BCRC) stating that the funds in the account have been used correctly. Individuals who have a CMS-approved WCMSA as part of a workers' compensation settlement agreement may only use the funds in the WCMSA account to pay for Medicare-covered medical services and Medicare-covered prescription drug expenses (less deductibles and copays) that are related to their workers' compensation injury, illness, or disease.
All authorized users who can access this page will see the following fields displayed on the page:
Table 1: Account Balance and Attestation Submission (All Authorized Users)
| Field | Description |
|---|---|
| Case ID | Displays the Case Control Number of the case. |
| Medicare ID | Displays the beneficiary’s Medicare ID (HICN or MBI). |
| Name | Displays the beneficiary’s first and last name. |
| Date of Injury | Displays the date of injury. |
Medicare Beneficiaries Who Are Not the Identified Case Administrator
If you are a Medicare beneficiary who is not the identified case administrator, this page can be used to view read-only summary details for your WCMSA case and view attestations that were previously submitted on the WCMSAP on your behalf. If you have questions about your account, this page will provide you with contact details so that you may contact your administrator. If contact information for your case administrator is not available in the system, this page will direct you to contact the Benefits Coordination & Recovery Center (BCRC) to resolve the issue.
Note: As a part of your settlement agreement, a professional administrator or other individual has been identified as the case administrator to manage your WCMSA funds and reports your annual attestation to Medicare.
The following information will be displayed (as applicable) on this page for the case.
Table 2: Account Balance and Attestation Submission (Non-Admin Beneficiary View)
| Field | Description |
|---|---|
| Total MSA | Displays the total approved MSA amount. Note: This field is only shown once this information has been transmitted successfully to Medicare’s central recordkeeping system. |
| Settlement Date | Displays the effective date of the settlement. Note: This field is only shown once this information has been transmitted successfully to Medicare's central recordkeeping system. |
| Payout Method | Displays the method of payout. Possible values: Lump Sum Structured Annuity Note: This field is only shown once this information has been transmitted successfully to Medicare's central recordkeeping system. |
| Initial Deposit | Displays the initial dollar amount of a structured payment schedule. Note: This field is only shown once this information has been transmitted successfully to Medicare's central recordkeeping system. |
| Current Balance | Displays the current balance. Note: This field is only shown once this information has been transmitted successfully to Medicare’s central recordkeeping system. |
| Anniversary Date | Displays the anniversary date of the annual payments. Note: This field is only shown once this information has been transmitted successfully to Medicare’s central recordkeeping system. |
| No. of Years | Display the number of years for the payout schedule to be calculated for. Note: This field is only shown once this information has been transmitted successfully to Medicare’s central recordkeeping system. |
| Payout Schedule | Displays the schedule of annual payments. Note: This field is only shown once this information has been transmitted successfully to Medicare’s central recordkeeping system. |
| View Attestations | Click this button to display the View Attestation Submissions page and view attestations that were previously submitted on the WCMSAP for the case on your behalf. Note: This button is only enabled when an attestation was previously submitted for the case via the WCMSAP or an update is made to the current balance. |
| Cancel | Click this button to return to the Case Documentation page. |
Identified Administrator of a Case Where Final Settlement Documentation Has Not Been Received
If you are the identified case administrator and final settlement documentation has not been received and validated, this page can be used to upload and submit that documentation.
Notes: You must submit an attestation to Medicare’s Benefits Coordination & Recovery Center (BCRC) stating the funds in the account have been used correctly no later than 30 days after the anniversary date of your Workers’ Compensation settlement. However, you will not be able to submit an attestation until final settlement documentation has been received and validated.
The following information will be displayed (as applicable) on this page for the case.
Table 3: Account Balance and Attestation Submission (Administrator View for Cases Where Final Settlement Documentation Has Not Been Received)
| Field | Description |
|---|---|
| Upload Documentation | Click this link to display the Attach Documentation page and upload a copy of the Final Settlement Agreement. |
| Delete | Click this link to delete the uploaded document. |
| Submit Files | Click this button to submit the uploaded documentation. Note: This button is only enabled when documentation has been uploaded. |
| Cancel | Click this button to cancel the submission process. All uploads for this submission will be deleted. |
Identified Administrator of a Case Where Final Settlement Documentation Has Been Received
If you are the identified case administrator and final settlement documentation has been received and validated, this page can be used to view summary details for your WCMSA case, view details for attestations previously submitted on the WCMSAP, and submit attestations related to the WCMSA case for which you are the administrator.
Note: You must submit an attestation to Medicare’s BCRC stating the funds in the account have been used correctly no later than 30 days after the anniversary date of your Workers’ Compensation settlement.
The following information will be displayed (as applicable) on this page for the case.
Table 4: Account Balance and Attestation Submission (Administrator View for Cases Where Final Settlement Documentation Has Been Received)
Note: The fields on this page are only shown once the case has been approved and this information has been transmitted successfully to Medicare’s central recordkeeping system.
| Field | Description |
|---|---|
| Total MSA | Displays the total approved Medicare Set-Aside (MSA) amount. |
| Settlement Date | Displays the effective date of the settlement. |
| Payout Method |
Displays the method of payout. Possible values: Lump Sum Structured Annuity |
| Initial Deposit | Displays the initial dollar amount of a structured payment schedule. Note: This field is only shown for structured annuities. |
| Current Balance | Displays the current balance. Notes: You may only update this field for an existing case that has been approved and this information has been transmitted successfully to Medicare’s central recordkeeping system before 10/7/19. Once this field has been updated and the first attestation has been submitted, this field will not be editable. |
| Anniversary Date | Displays the anniversary date of the annual payments. |
| No. of Years | Displays the calculated number of years for the payout schedule. |
| Payout Schedule | Displays the schedule of annual payments. Note: This field is only shown for structured annuities. |
| View Attestations | Click View Attestations to display the View Attestation Submissions page and view attestations that were already submitted for the case. Note: This button is only enabled when an attestation was previously submitted for the case via the WCMSAP or an update is made to the current balance. |
If you are the identified administrator for the WCMSA case, you can submit your attestation from this page. To submit your attestation:
1. Click the applicable attestation statement and enter the attestation start and end dates (as applicable).
2. Enter the amount of any medical and prescription drug expenses paid (as applicable).
3. Enter any taxes paid on interest earned on the WCMSA funds, as well as the interest earned on these funds (as applicable).
4. Enter the balance of the WCMSA account at the end of the attestation period (as applicable).
5. Select the checkbox to agree with the acknowledgement statement.
6. If you are submitting supporting documentation with your attestation, click the Upload Documentation link which will display the Attach Documentation page. Click the Delete link to delete the uploaded document (as necessary).
7. Click Submit Attestation to submit the attestation or click Cancel to cancel the submission process and return to the Case Documentation page. Note: All uploads for this submission will be deleted if cancel is clicked.
January 2025
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