MIR-2006-10AB, October 2006

National Recovery Contractor for New Medicare Secondary Payer (MSP) Recovery Claims

The Centers for Medicare & Medicaid Services (CMS) has awarded a contract for a national Medicare Secondary Payer Recovery Contractor (MSPRC) to Chickasaw Nation Industries, Inc. – Administration Services, LLC (CNI). This contract will be implemented on October 2, 2006.

Please read the sections immediately below to determine how the change to a national MSPRC will affect you, as some existing MSP recovery claims will remain the responsibility of the claims processing contractors.

What does implementation of the MSPRC mean for you if you are a provider, physician, or other supplier?
The recovery of provider, physician, or other supplier MSP recovery claims will continue to be the responsibility of the contractor which processed the underlying Medicare claim. Consequently, providers, physicians, and other suppliers should not see any changes in CMS’s processes for recovering debts where the provider, physician, or other supplier is overpaid due to receiving a duplicate payment from both an insurer or workers’ compensation carrier and Medicare.

What does implementation of the MSPRC mean for you if you are: (a) an employer, insurer, GHP, third party administrator, or other plan sponsor subject to the MSP GHP provisions of the Social Security Act; (b) a workers’ compensation plan/carrier or a liability or no-fault insurer; (c) a beneficiary (or the representative of a beneficiary)?
For all new MSP initial recovery demand letters issued on or after the implementation date for the MSPRC (October 2, 2006), you should respond to the entity which issues the recovery demand letter to you. Except for provider, physician, or other supplier MSP recovery claims and a limited number of GHP debts in certain states, this will routinely be the MSPRC.

General Rules
The MSPRC will have responsibility for all new MSP recovery demand letters issued on or after the implementation date for the MSPRC (October 2, 2006), as well as all subsequent CMS actions on those recovery claims. The two exceptions to this are recovery demand letters issued by the MSP Recovery Audit Contractors (RACs) implemented as a demonstration under the Medicare Modernization Act of 2003 and MSP recovery demand letters issued by the claims processing contractors to providers, physicians, and other suppliers. The RACs will continue to have responsibility for certain MSP GHP based recovery demands for the states of California, Florida, and New York. The three MSP RACs are:

- Diversified Collection Systems (California),
- Public Consulting Group (Florida), and
- Public Consulting Group (New York).

NOTE : The responsibility for all pending MSP recovery cases where a recovery demand letter has not yet been issued will, aside from the two exceptions noted in the preceding paragraph, be the responsibility of the MSPRC. (Please note that a letter providing the amount of Medicare’s conditional payments in connection with a workers’ compensation or liability or no-fault insurance case is not a recovery demand letter.) This responsibility is in line with the MSPRC’s responsibility for the issuance of all new MSP recovery demand letters issued on or after October 2, 2006 (again, with the two exceptions noted in the preceding paragraph).

Due to systems issues, the Medicare contractors listed immediately below will continue to have responsibility for all further CMS collection actions with respect to MSP recovery claims where the initial recovery demand letter was issued prior to the implementation date of the MSPRC (October 2, 2006). This includes responsibility for the “Notice of Intent to Refer Debt to the Department of Treasury” where a recovery claim is not repaid timely. The RACs will also continue to have this responsibility for all RAC-initiated MSP recovery claims .

• Empire – Syracuse, NY or Harrisburg, PA
• First Coast Service Options – Jacksonville, FL
• Mutual of Omaha – Omaha, NE
• Palmetto – Augusta, GA or Columbia, SC or Columbus, OH
• Trailblazer – Denison, TX

The MSPRC will have responsibility for all further CMS collection actions for MSP recovery demand letters issued before the implementation date for the MSPRC (October 2, 2006) unless the recovery demand letter was: (1) issued by one of the Medicare contractors listed immediately above; (2) issued by one of the RACs; or (3) issued to a provider, physician, or other supplier.

Once a recovery claim is referred to the Department of the Treasury, the contractor which issued the recovery demand letter and the Notice of Intent to Refer the Debt to Treasury will take no further collection action. You should direct any further correspondence to the Department of the Treasury (or its contractor if you have received correspondence from an entity under contract to the Department of the Treasury).

Contact Information for the MSPRC
MSPRC telephone access will not be available before October 2, 2006. The number for the MSPRC’s dedicated call center will be 1-866-MSP-RC20 (1-866-677-7220), available from 8:00 a.m. to 8:00 p.m. Eastern time, Monday through Friday, with the exception of holidays.

The MSPRC will not accept mail until September 25, 2006. Mailing information for the MSPRC will be available on CMS’s Web site after September 22, 2006.

The MSPRC is a recovery contractor.

• The appropriate contact for reporting changes in group health plan (GHP) insurance coverage, or reporting non-GHP claims (workers’ compensation, liability insurance (including self-insurance), or no-fault insurance) remains CMS’s Coordination of Benefits Contractor (COBC). Initial contact for parties wishing to propose a workers’ compensation Medicare set-aside amount also remains with the COBC. See http://www.cms.hhs.gov/COBGeneralInformation/ for further information about the COBC, including contact information, attorney information, etc. The COBC’s toll-free line is 1-800-999-1118 (TTY/TDD 1-800-318-8782 for the hearing and speech impaired).
• The CMS Medicare claims processing contractors continue to be responsible for claims processing for Medicare billing involving Medicare as a secondary payer.

CMS Joint Signature Memorandum (JSM)-06686