Benefits Coordination and Recovery Center (BCRC) …...• Benefits of BCRC • Questions 2 BCRC...
Transcript of Benefits Coordination and Recovery Center (BCRC) …...• Benefits of BCRC • Questions 2 BCRC...
Benefits Coordination and
Recovery Center (BCRC)
Overview
Agenda• BCRC Responsibilities• BCRC Processes
– Overview of Data Collection process– Overview of Recovery process
• Medicare Secondary Payer Recovery Portal (MSPRP) Overview• BCRC Contact Information• Call Center
– IVR Tips– Virtual Hold
• Benefits of BCRC• Questions
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BCRC Responsibilities
• Determining who pays Medicare claims first
• Ensuring claims are paid correctly
• Sharing Medicare eligibility data with other primary payers
• Avoiding duplicate payments
• Sending claims data to other insurers
• Recover conditional payments or mistaken benefit payments
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How it works
BCRC
Recovery CenterData Collection
Collects information from multiple sources to research MSP situation.
• Section 111 Mandatory Insurer Reporting and Data Sharing Agreements (DSAs)
• Self Report (phone or portal)
• Workers Compensation Set-Asides
Responsible for identifying and recovering Medicare conditional and mistaken payments that should have been paid by another entity as the primary payer
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Overview of the Data Collection (DC)
Process
How Does BCRC Collect Information?
• Self Report (Call, Fax, Mail)– Attorney, Beneficiary, Insurer, Provider, etc.
• Data Sharing Agreements (DSA)– DSA – Data Sharing Agreement
• Mandatory Insurance Reporting (Section 111)• Group Health Plan (GHP)
• Non-Group Health Plan (NGHP) - No-Fault (NF), Workers’ Compensation (WC), and Liability
• Electronic Correspondence Referral System (ECRS)• MSP and Prescription Drug Assistance Requests
• MSP and Prescription Drug Inquiries
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Insurers, Beneficiaries, Providers or
Attorneys report a GHP, NGHP or
request information on Coordination
of Benefits (COB)
BCRC asks probing questions or
sends a development letter to
determine if the beneficiary’s
MSP record is accurate
Overview of the DC Process
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Option 1 - Reporting new GHP record
BCRC collects information
by completing an MSP
development questionnaire
In 48 hours systems
are updated
MSP confirmation letter is
sent to beneficiary
Overview of the DC Process
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BCRC collects information
by completing an MSP
development questionnaire
In 48 hours systems
are updated
MSP confirmation letter
is sent to beneficiary
Overview of the DC ProcessOption 2 - Reporting new NGHP record
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Option 2 - Reporting new NGHP record
System receives
electronic information
and creates a Lead
System forwards all NF and WC leads to the
Commercial Repayment Center (CRC)
Overview of the DC Process
System forwards all Liability leads to the BCRC
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Overview of the Recovery
Process
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Accident/incident/
illness occurs
Beneficiary goes to
hospital/doctor
Hospital/doctor
submits claim for
payment
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Recovery Process
Medicare makes
conditional payments
for services
Case is reported to
BCRC and information
is gathered
Rights and
Responsibilities (RAR)
Letter is issued
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The payment is “conditional” because it must be
repaid to Medicare if/when a settlement, judgment, award or other payment is secured
Recovery Process
The search for
Medicare
Claims begins
Medical claims related to the
incident are identified and a
Conditional Payment Letter
(CPL) is issued
Claims may be
disputed from the CPL if
recipient feels they are not
accident related
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Recovery Process
• Settlement, judgment, award, or
other payment is reached
• Notice of Settlement must be
submitted to the BCRC
The final conditional payment
amount is identified and a
Demand Letter is sent
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Recovery Process
Option 1 - Payment
A check is received for
demand amountMSP Recovery
Case Complete
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Recovery Process
Option 2 – Issues Arise
A post demand inquiry is sent.
(e.g. questions, appeals,
request for waiver, etc.)
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Recovery Process
• Appeal – disagreement with the
existence of the full/partial
overpayment amount
• Waiver – request for the entire
overpayment amount to be
forgiven
• Compromise – request for a
partial amount of the
overpayment to be forgiven
Interest is assessed if
the debt is not
resolved within 60
days from date of
demand
If full repayment is not
received within 60 days
from date of demand, an
Intent to Refer Letter (ITR)
is issued
If full repayment is not
received within 60 days of ITR
Letter (120 days of demand),
debt is referred to Treasury
once any outstanding
correspondence is worked
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Option 3 – Intent To Refer
Recovery Process
Medicare Secondary Payer Recovery Portal (MSPRP) High level Overview
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Case Access
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Request Case Access
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Bene Debtor vs. Insurer Debtor
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Bene Debtor Insurer Debtor
CMS is pursuing recovery from the beneficiary
CMS is pursuing recovery from an insurer
Case ID begins with a 2 Case ID begins with a 3*
BCRC sends correspondence• Beneficiary is the primary recipient• Authorized parties receive carbon
copies
CRC* sends correspondence• Insurer is the primary recipient• Beneficiary and any authorized parties
receive carbon copies
Beneficiary and those authorized by the beneficiary can take action on the case
Insurer and those authorized by the insurer can take action on the case
Report a Case
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Case Information
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Case Actions
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Contact Information
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Area Number
BCRC Call Center 855-798-2627
TTY Number 855-797-2627
Data Collection and Authorizations Fax Line
405-869-3308
Recovery Documents FaxLine
405-869-3309
Workers CompensationSet-Aside (WCSA) Fax Line
405-869-3306
MSP Data Collection Fax Line
405-869-3307
EDI Hotline 646-458-6740
Medicare Commercial Repayment Center (CRC)
NGHP – No-Fault & Workers Comp
Commercial Repayment Center- NGHPPO Box 269003Oklahoma City OK, 73126NGHP Fax Line- 844-315-7627
GHP
Commercial Repayment Center- GHPPO Box 248909Oklahoma City, OK, 73124GHP Fax Line- 844-315-4313
Contact Information
BCRC Area Address
MSP Data Collection
Data Collection Authorization
Data Collections AuthorizationsPO Box 138898Oklahoma City, OK 73113
Medicare MSP General Correspondence
Medicare-MSP General CorrespondencePO Box 138897Oklahoma City, OK 73113
Medicare MSP Claims Investigation Project
Medicare-MSP Claims Investigation ProjectPO Box 138897Oklahoma City, OK 73113
Data Sharing AgreementDSA ProgramPO Box 138897Oklahoma City, OK 73113
Workers Compensation Set-Aside Arrangement Proposal
WCMSA Proposal/Final StatementPO Box 138899Oklahoma City, OK 73113
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Contact Information
BCRC Area Address
Recovery
NGHP Inquiries/Checks/Recovery AuthorizationsNGHPPO Box 138832Oklahoma City, OK 73113
Fixed Percent OptionFixed Percent OptionPO Box 138880Oklahoma City, OK 73113
Special Projects (Product Liability Case inquiries and SP Checks)
Special ProjectsPO Box 138868Oklahoma City, OK 73116
Self Calculated Conditional Payment OptionSelf-Calculated Conditional PaymentPO Box 138880Oklahoma City, OK 73113
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IVR Tips
• 855-798-2627
• First Menu– Beneficiary- Press 1
– Calling about Beneficiary- Press 2
– Commercial Repayment Center- Press 4
– Selection must be made at this menu before pressing “0” for an agent
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IVR Tips• Beneficiary Menu
– 800 Medicare transfer- Press 1– Otherwise Press 2 for BCRC
• Complete Authentication via speech recognition (4 pieces)– Medicare Beneficiary Identifier (MBI) can be captured here with speech– If Social Security Number is used the, the 4th piece will be Entitlement Date
• Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on Beneficiary File
• Unsuccessful Authentication– Call is transferred to an agent
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IVR Tips
• Other Caller Menu– Provider- Press 1
– RRE- Press 2
– Attorney- Press 3
– Agent, Other Rep- Press 4
– Employer- Press 5
– DSA- Press 642
IVR Tips
• Authentication will vary based on caller type– Provider/RRE/DSA
• 2 pieces to identify entity• 2 pieces for Beneficiary
– Speech has been added to the Medicare prompt to collect the Medicare Beneficiary Identifier (MBI)
• Successful Authentication– Coverage Status provided– Presented Dynamic Menu based on information on Beneficiary
File
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IVR Tips
• Authentication (continued)– Attorney/Third Party Administrator (TPA)/Other
Representative • 4 pieces for Beneficiary
– Speech has been added to the Medicare prompt to collect the MBI
– Unsuccessful Authentication– Call is transferred to an agent
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Self Service Information• Coverage Status
– Medicare Primary Versus Secondary– Status on Specific Date
• Entitlement Information– Date– Reason
• ESRD Information– Date of Dialysis– Coordination Period
• Recovery Information– RAR Date– CPL Mail Date and Amount– Demand Mail Date and Amount
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Virtual Hold
• Call Center offers Virtual Hold
– Offers to call back while holding place in the queue
– Once called back, agent is ready to assist
– Saves time by not waiting on hold
– Enhances customer experience
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How BCRC Benefits our Customers
• Enhanced Beneficiary experience because claims are processed with greater efficiency due to accurate records
• More timely processing of beneficiaries’ medical claims reduces employers administrative expenses
• Reduces cost of recouping payments made in error and ensures integrity of Medicare Trust Fund
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Questions?
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