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MSPRP User Manual

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1. SERVICES i Uy Y CENTERS for MEDICARE amp MEDICAID SERVICES Centers for Medicare amp Medicaid Services Office of Financial Management Financial Services Group 7500 Security Blvd Baltimore MD 21244 1850 MSPRP Medicare Secondary Payer Recovery Portal User Manual Rev 2012 1 July GHI DI 108 1 0 MSPRP User Manual Table of Contents Table of Contents Chapter 1 Introducti oisinnean dh ca deuaap sites coc EE a EEE a a aE bevel AE E niente ae 4 VEL VIEW fescciscondestizce sitvasebeb doiots lissideel Gee evarpetidaeiees MarR Hh A EEA EE OEE AEE EE A Baal 4 ACCOUME TYPOS isa s ceciangsopssesscnices ta dettessscponevesacondessatucesse E beustssunchacsesccu lees suseatessasusiesodbgsiesssseazsctseeureuees 4 USEF ROLES si cpetseccecnnseecotines ccek sveds cusevvbea EATA LA E a SEa e ERE EES i 5 Account Representative AR ROl nescera i i a i 5 Account Manager AM ROlesssinrsri csiis enirere einne EE SERES ESA E ERS EE ET S 5 Account Designee AD Role eesseessessseesseesseessressressressresstesstesseesseesstesstesssessesseessseeseeeseeeseseseseseeseeee 6 Beneficiary ROC as crecer vii rion eiie EEA E EEEE E EE lasses ee ai E A AE OE S E E det 6 Login TD and Password Leninits iy csc ios casts arees cadesiencndagdsedsebensvevessezysobsachugacsadbedsslapbosnensceesathec Coucdkadevrasdestione 6 Electronic Data Interchange EDI Representative Support eee ceeceseeseeeeeeeseeeseee
2. Medicare Secondary Payer Recovery Portal Welcome Page Privacy Policy User Agreement 4 You can select another option from the page or click Logoff to exit the portal You must enter the new password the next time you login to the MSPRP system Rev 2012 1 July Page 87 MSPRP User Manual Chapter 8 Account Designee Chapter 8 Account Designee Account Designees AD are optional users associated with an Account ID who assist the Account Manager AM in managing a Corporate or Representative account As a Designee you will be able to perform most of the functions on the site including sending cases but will not be able to invite additional users to be associated with the Account ID or enter company information ADs are assigned by the Account Manager After the AM adds you to an account the system sends you an invitation E mail containing a specific URL It is necessary for you to use this URL as it contains a specific token which grants access to the registration site You will also verbally receive a Passphrase from the Account Manager which must be entered during the registration process The token link becomes inactive after 30 days of non use so it is imperative to register as soon as possible after receiving the invitation E mail As an Account Designee you register yourself on the MSPRP using the information contained in the system generated E mail sent and the Passphrase given to you by the Account Mana
3. Claims Dispute Confirmation POORE You have successfully submited the Claims listed below for dispute associated to Case ID 20110 00000 00000 Help Adout This Page Cack Continue will retum you to the Case Information page Claims Disputed Claim Control 1D ICN eens Total Charges Reimbursed Amount Conditional Payment sere 9999999 1 205 00 77 05 77 05 sese 9999999 2 165 00 56 09 56 09 You have successfully submited the following documentation for Me case Usted above testpoti23 pat Cack Continue wil retum you fo the Case information page 5 Click Continue to return to the Case Information page You will be able to dispute another claim Rev 2012 1 July Page 133 MSPRP User Manual Chapter 10 Request Case Access Provide the Notice of Settlement Information Selecting this option allows you to enter Notice of Settlement information upload supporting documentation for a settlement or elect the Fixed Percentage option Completion of this page will result in the issuance of a demand bill The Settlement Information page is displayed Rev 2012 1 July Page 134 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal CENTERS for MECICARE MIONA SERVICES Quick Help Settlement Information a Help About This Page This page allows you to enter Notice of Settlement information upload Notice of Settlement documentation or elect the Fixed Percen
4. Command Buttons Continue Cancel Click to save changes and continue to the next page Click to cancel changes and return to the Designee Listing page 4 The Designee Listing page re displays with the Designee s information unchanged However the system re generates the invitation E mail and sends it to the E mail address registered for the Account Designee Designee Listing This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individual as a designee Individuals added as designees will receive an e mail notifying them that they have been invited to be a designee for the sccount Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status x AAAA AAAAA AAA AAA AAA AAA AAA AAA AAAA Add Designee gt Cancel 3 atta Privacy Policy User Agreement Below is a sample of a system re generated email invitation Note The
5. Zip Code Enter your zip code required plus 4 digit zip code suffix optional Command Buttons Previous Click to return to the Select Account Type page Continue Click to save changes and continue to the next page Click to cancel the registration process Information entered on the current page and Cancel any previous pages is NOT saved Rev 2012 1 July Page 22 MSPRP User Manual Chapter 3 New Registration 2 The Beneficiary Information page is displayed You must submit information for a beneficiary that will have MSPRP requests submitted under this Account ID Enter the required information in the provided fields Then click Continue Medicare Secondary Payer Recovery Portal About This Site CMS Links An asterisk indicates a required field Beneficiary Last Name Beneficiary Health Insurance Claim Number HICN Beneficiary Social Security Number SSN Beneficiary Date of Birth Beneficiary Gender Beneficiary Last Name First Initial Beneficiary Health Insurance Claim Number HICN Beneficiary Information Carei A A Reference Materials Help About This Page First Initial SSN is required if HICN is not provided MM DDICCYY Privacy Policy User Agreement Beneficiary Information Page Description Enter the beneficiary s last name Enter the beneficiary s first initial Enter the beneficiary s HICN If you enter
6. First Name MI Last Name Social Security Number E Mail Address Re enter E Mail Address Phone g g lt i J ext o Fax Mailing Address Address Line 1 Address Line 2 City State Select z Zip Code Privacy Policy User Agreement Representative Information Page Field Description First Name Enter your first name MI Enter your middle initial optional Last Name Enter your last name Rev 2012 1 July Page 21 MSPRP User Manual Chapter 3 New Registration Enter your social security number A social security number cannot be registered more Social Security Number than once This cannot be edited after registration Enter your E mail address E mail Address Note If your E mail address is found in the system as an existing user you will NOT be allowed to continue the registration process Re enter E mail Address Enter your E mail address a second time for verification purposes Phone Enter your phone number The ext extension field is optional Fax Enter your fax number optional Address Line 1 Enter the first line of your mailing address Address Line 2 Enter the second line of your mailing address optional City Enter the city where you are located out Select the state where you are located from using the drop down list ate Note To quickly select a state type the first letter to scroll to the desired state
7. Enter your E mail address a second time for verification purposes Phone Enter your personal phone number Ext Address Line 1 Address Line 2 Enter the extension for your phone number optional Enter the first line of the company s mailing address Enter the second line of the company s mailing address optional City Enter the city where the company is located State Select the state where the company is located from the drop down list Note To quickly select a state type the first letter to scroll to the desired state Zip Code Enter the company s zip code required plus 4 digit zip code suffix optional Rev 2012 1 July Page 52 MSPRP User Manual Chapter 7 Account Settings for Account Manager Command Buttons Continue Click to save changes and continue to the next page Cancel Click to return to the Welcome page Personal Information First Name FIRST Mi M Last Name LAST E Mail Address AAAA AAA AAA Phone HHHHH ext Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code Ha Personal Information Update Confirmation Your information has been updated Print this page for your records Privacy Policy User Agreement y y g 5 Review the updated information You can print this page by clicking the Print this page link Click Continue to return to
8. 4 Upload Documentation To upload supporting documenation please click here Note Please submit settlement related documentation only Any other documents submitted will not be reviewed Below is a list of documents to be submitted for the case If you d like to delete a document from the list click the Delete link to the right of the document name AAAAPDF Delete Selecting Continue will submit the files to CMS Selecting Cancel will return you to the Case Information page the files will not be submitted to CMS 2T y Policy User Agreement Rev 2012 1 July Page 135 MSPRP User Manual Chapter 10 Request Case Access Field Description Injury Type Select the injury type Traumatic or Non traumatic Settlement Amoni Enter the dollars and cents for the settled payment amount Enter the settlement payment date Settlement Date Select this option if there were any attorney fees Attorney Fees If there were attorney fees enter the dollar amount in the Attorney Fees or Attorney Expenses fields If the attorney is receiving a percentage of the settlement amount enter the percentage Attorney Fee Percentage number Fixed Percentage Option If there was a fixed percentage applied to the settlement amount select this option If there are other parties that need to be paid or other exclusions for this settlement MED PIP Other Exclusions enter the dollar amount in this field Command Bu
9. Help About This Page Case Information below Authorization Status Demand Letter Mail Date Date that the demand letter was sent out to the debtor Demand Amount Full amount owed by the debtor Requesting Case Information Table You can select an option from the following list If the option is not active it may not be available for this case Action Description This action allows you to request the most current information Request an update to the conditional payment about your conditional payment amount You must request that amo nt your account be updated This process will retrieve all additional medical claims and determine what should or should not be associated to the case This action allows you to submit a request for a copy of the Request a copy of the conditional payment original Conditional Payment Letter that was sent out with the letter current conditional payment amount as displayed on the case information screen This action allows you to see a list of all medical claims View Dispute Claims Listing associated with the case This action allows you to enter settlement payment amount fixed Provide the Notice of Settlement Information percentage options Rev 2012 1 July Page 107 MSPRP User Manual Chapter 9 Beneficiary Request an Update to the Conditional Payment Amount Selecting this option will allow you to request current information about conditional payment amount Y
10. Last Name Enter your last name AR Title Enter your job title E mail Address Enter your Account Representative E mail address Note If your E mail address is found in the system as an existing user you will NOT be allowed to continue the registration process for Corporate accounts Re enter E mail Address Phone Fax Enter your Account Representative E mail address a second time for verification purposes Enter your Account Representative work phone number The ext extension field is optional Enter your Account Representative work fax number optional Command Buttons Previous Click to return to the Corporate Information page Continue Click to save changes and continue to the next page Cancel Click to cancel the registration process Information entered on the current page and any previous pages is NOT saved 3 The Registration Summary page displays This page lists all the information that was previously entered All information must be reviewed and verified before continuing Registration Summary Plesse review your registration information If you need to change the information click the Edi button If you are satisfied with the information click the Submit Registration button to submit the registration Click the Cancel button to cancel the process all data will be lost Click the Previous button to return to the previous screen Print this
11. Re enter Email Address Re enter your E mail address a second time for verification purposes Address Line 1 Phone Enter your personal phone number Ext Enter the extension for your phone number optional Fax Enter your fax number Enter the first line of the company s mailing address Address Line 2 City State Zip Code Command Buttons Enter the second line of the company s mailing address optional Enter the city where the company is located Select the state where the company is located from the drop down list Note To quickly select a state type the first letter to scroll to the desired state Enter the company s Zip Code required plus 4 digit Zip code suffix optional Previous Click to return to the prior page Continue Click to save changes and continue to the next page Cancel Click to return to the Welcome page Any information you entered will not be saved Rev 2012 1 July Page 64 MSPRP User Manual Chapter 7 Account Settings for Account Manager 4 The Update Account Information page displays your updated information Click Continue to proceed to the Update Account Information Confirmation page Skip Navigatior Update Account Information gt ee Help About This Page You may edit the Account Representative personal information or mailing address by clicking on the Edit button of that section You may not change the account type or change the
12. User Agreement Rev 2012 1 July Page 30 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup 7 The Account Setup page is displayed Enter the Account ID PIN and Account Manager s E mail Re enter the E mail Address for verification Then click Continue Note If you are registering as an Account Manager for a Corporate account and the E mail address you enter here is found in the system you will be prohibited from continuing the account setup process Medicare Secondary Payer Recovery Portal CMS Links Reference Materials Account Setup Help About This Page Plesse enter your Account Identification Number Account ID and Personal Identification Number PIN which was sent to the account contact after completion of the New Registration step We also ask for your E mail address to see if you sre already sssocisted to another account on the MSPRP Existing users will not be allowed to be associated to multiple MSPRP accounts New users must go through the process of esting a Login ID and Password An asterisk indicates a required field Account ID Personal Identification Number PIN Account Manager s E mail Address Re enter E mail Address Privacy Policy User Agreement Account Setup Page Field Description Account ID Enter the Account ID listed on the letter received from the EDI Department Personal Identification Number PIN Enter the PIN listed
13. Zip Code Enter the company s Zip Code required plus 4 digit Zip code suffix optional Command Buttons Continue Click to save changes and continue to the next page Cancel Click to return to the previous page 2 The Personal Information Update Confirmation page is displayed You can print this page using the Print this page link Or click Continue The Account List page is displayed again Reference Materials Personal Information Update Confirmation gt Prim mis page Help About This Page Your informastion has been updsted Print this page for your records Personal Information First Name AAAA MI A Last Name AAAA E Mail Address AAAAAAAAAA Phone 4322352 ext Mailing Address Address Line 1 AAAAAAASAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code Se Privacy Policy User Agreement Rev 2012 1 July Page 102 MSPRP User Manual Chapter 8 Account Designee Change Password Click Change Password from the Account Settings box This page allows you change your login password Refer to the Change Password section in Chapter 7 Accounts Settings for Account Managers Rev 2012 1 July Page 103 MSPRP User Manual Chapter 9 Beneficiary Chapter 9 Beneficiary Login to MSPRP Beneficiaries will access the Medicare Secondary Payer Portal MSPRP through the MyMedicare Web site at https mymedicare gov MyMedicare allows the Beneficiary t
14. Cancel EJ Privacy Policy User Agreement E mail Address Re enter E mail Address Phone Ext Command Buttons Previous Continue Cancel Field Description AR First Name Enter your first name You must be the Account Representative MI Enter your middle initial optional Last Name Enter your last name AR Title Enter your Account Representative title Enter your personal E mail address Enter your E mail address a second time for verification purposes Enter your personal phone number Enter the extension for your phone number optional Click to return to the prior page Click to save changes and continue to the next page Click to return to the Welcome page Rev 2012 1 July Page 59 MSPRP User Manual Chapter 7 Account Settings for Account Manager 8 The Update Corporate Information page is displayed This page displays the updated information Click Continue to proceed _ Update Corporate Information eae You may edit the Corporate Account information or Account Representative information by clicking on the Edit button of thst section You may not change the account type Click the Continue button to submit the changes Click the Cancel button to return to the Home Page sll changes will be lost Help About This Page Account Type Corporste Corporate Information Account Representative AR Information Employer Identification Number EIN 488888Ht Co
15. Help About This Page Forgot Password Confirmation Your password for the Medicare Secondary Payer Recovery Portal MSPRP has been successfully reset _ NEXT STEPS You will receive an e mail with a temporary password and instructions to follow Please note The e mail message will be sent from a notification only address that cannot accept incoming e mail Please do not reply to it If you do not receive your e mail within 24 hours please call the EDI Help Desk Department st 646 458 6740 EDI Representatives sre available to assist you Monday through Friday excluding Federal holidays from 9 00 a m to 5 00 p m Esstern Time Medicare Secondary Payer Recovery Ports Welcome Page Privacy Policy User Agreement 5 Click the Medicare Secondary Payer Recovery Portal Welcome Page link to return to the Welcome to the MSPRP page 6 When you log back in enter the temporary password provided in the E mail You must change your temporary password the next time you log into the MSPRP Rev 2012 1 July Page 49 MSPRP User Manual Chapter 6 MSPRP Welcome Page after Successful Login Chapter 6 MSPRP Welcome Page after Successful Login About The Welcome Home Page The MSPRP Welcome page is the first page displayed after a successful login from the Welcome to the MSPRP page This page functions as the main processing page to initiate all MSPRP functions This is considered to be your home page This pa
16. Rev 2012 1 July Page 145 MSPRP User Manual Chapter 11 Manage Case Access ow To s Contact Us onol Welcome Navigate to field descriptions Link opens The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and in a new window provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims You may modify Account Settings by clicking the appropriate link under the Account Settings list To request information regarding a case you have not already associated to your account click the Request Case Undete Personal Infosmation Access link below Update Account Information Designee Maintenance To see cases that you have previously associated to your account click the Case Listing link below View Account Activity Change Password Request Case Access Case Listing 3 Click Case Listing The Case Listing page is displayed Rev 2012 1 July Page 146 MSPRP User Manual Chapter 11 Manage Case Access Reference Materials Case Listing o TE Help About This Page The following are the case inquiries associated to Account ID 99999 To view case detail information click the case number To manage Designee access to the case click on the Manage Access link To perform a search enter the search cr
17. character Password must contain a minimum of four 4 changed characters from the previous password Password cannot be changed more than once per day Password must be different from the previous 6 passwords Password cannot contain a reserved word See Help About This Page for a complete list An asterisk indicates a required field Enter your current password Enter your new password Re enter your new password eat gt Cancel x Privacy Policy User Agreement Rev 2012 1 July Page 86 MSPRP User Manual Chapter 7 Account Settings for Account Manager Field Description Enter your current password Enter your password Enter your new password Enter your new password using the password guidelines listed Re enter your new password Re enter your new password a second time for verification purposes Command Buttons Continue Click to save changes and continue to the next page Cancel Click to return to the Account Setup Intro page 3 This page indicates that your password has been changed successfully You will be required to use the new password the next time you log into the MSPRP Click Medicare Secondary Payer Recovery Portal Welcome Page to continue to the Welcome page Change Password Confirmation Help About This Page You have successfully changed your password You will be required to use the new password on your next login attempt
18. excluding Federal holidays from 9 00 a m to 5 00 p m Eastern Time Rev 2012 1 July Page 152 MSPRP User Manual Chapter 13 Troubleshooting 3 Concurrent Sessions 1 Help about this page Concurrent Sessions Detected This LOGIN ID is already logged into the system Select cancel to terminate this new session and continue using the existing session Select continue to terminste the existing session and oeste a new session Caution Choosing continue may result in the loss of sny unsaved dats P cone oa Rev 2012 1 July Page 153
19. 2012 1 July Page 116 MSPRP User Manual Chapter 10 Request Case Access New Case Request This page verifies that you have access to a specific recovery case You will need to enter the recovery Case ID and beneficiary information 5 Enter the requested information and then click Continue Medicare Secondary Payer Recovery Portal Skip Navigatio Home About This Site CMS Links ow To Reference Materials Contact Us Logoff Quick Help New Case Request wiek Heip O Help about this page The informastion requested below will be systematically validated to ensure you have the appropriate authority to access the ReMAS case Once the information is validated you can perform specific actions on the case upload corresponding documentation in PDF file formst request conditional payment letter To begin the new case inquiry process enter the required data and click the Continue button To cancel the case cestion click the Cancel button to return to the Home page ReMAS Case ID HICN OR SSN Last Name at least first five letters MM DDICCYY oa ae gt Cancel EJ a Field Description ReMas Case ID Enter the recovery case identification number Beneficiary HICN Enter the Medicare number for the beneficiary on the case as entered when the case was created Enter the social security number for the beneficiary on the case as entered when Beneficiary SSN the case was created Last Name Enter the be
20. Account Manager Delete a Designee from an Account 1 On the Home page click the Designee Maintenance link in the Account Settings box Update Personal Information Update Account Information Designee Maintensnce View Account Activity Change Password 2 The Designee Listing page displays with all Designees and their associated statuses Pending Active Locked Expired Revoked listed Skip Navigatio Logoff Designee Listing Oman Help About This Page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individual ss a designee Individuals added ss designees will receive an e mail notifying them thst they have been invited to be a designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status AAAAA AAA AAA AAA AAA AAA AAA AAAA AAAAA AAA AAA AAA AAA AAA AAA AAAA Cancel 3 Privacy Policy User Agreement
21. Cancel and select the View Dispute Claims Listing option to submit a dispute Please do not submit a dispute as part of the settlement documentation An asterisk indicates a required field Injury Type Traumatic Injury e g Slip and Fall or Auto Accident Non traumatic Injury e g Alleged injury resulting from exposure implantation or ingestion of a substance Settlement Amount gt i 0 00 999 999 999 00 Settlement Date I I MM DDICCYY Settlement Details Please choose one of the following options Note If nothing is entered this request will be processed without Attorney Fees None Attorney Fees What are Attorney Fees Attorney Fees 0 00 999 999 999 00 Attorney Expenses 0 00 999 999 999 00 Attorney Fee Percentage Fixed Percentage Option What is Fixed Percentage Option Exclusions MED PIP Other Exclusions 0 00 999 999 999 00 What are Exclusions attest that the settlement information provided above is correct Official Settlement Documentation court documents is not required unless needed to resolve relatedness issues on conditional payments made In certain situations CMS may require a detailed breakdown of attorney fees and expenses to be provided uploaded Upload Documentation To upload supporting documenation please click here Note Please submit settlement related documentation only Any other documents submitted will not be
22. Designee an E mail is generated and sent to the intended Designee informing them of the invitation The E mail includes a token link for the user to access the MSPRP site and self register as an Account Designee If the intended Designee has misplaced or deleted the invitation E mail or if the Designee has not registered within 30 days the Account Manager can regenerate the invitation E mail allowing the intended Account Designee to self register Note The previously generated token link will not work once a new E mail is generated Invitation E mails can only be regenerated for Designees in Pending status The E mail will come from cobva ghimedicare com Inform your Designee to allow E mail deliveries from this address 1 On the Home page click the Designee Maintenance link in the Account Settings box Account Settings Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password 2 On the Designee Listing page click the last name of the Designee Designee Listing Print tls page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account
23. EMAIL Dear Name You have been invited by First Last for Account ID 99999 to participate in the Medicare Secondary Payer Recovery Portal MSPRP web portal process Please follow this link to register https qua cob cms hhs gov MSPRP designeeRegistration token pZDiww MBtwwMbw If you have already registered please visit the Medicare Secondary Payer Recovery Portal Welcome Page at https qua cob cms_hhs gov MSPRP to login For any questions or problems please contact the person named in the paragraph above This electronic message transmission is intended only for the person or entity to which it is addressed and may contain information that is privileged confidential or otherwise protected from disclosure If you have received this transmission but are not the intended recipient you are hereby notified that any disclosure copying distribution or use of the contents of this information is strictly prohibited If you have received this e mail in error please contact the Electronic Data Interchange EDI Department at 646 458 6740 and delete and destroy the original message and all copies Rev 2012 1 July Page 70 MSPRP User Manual Chapter 7 Account Settings for Account Manager If the entered E mail address is NOT found in the system the Designee Invitation page displays Enter the invited Designee s First Name Last Name and Passphrase You will need to create this passphrase Note The Passphra
24. Information ail Account Representative AR Eai Information Employer Identification Number EIN 888HHHHt Corporate Name AAAAAAAAAA First Name AAAA MI A Last Name AAAA Business Mailing Address Title AAAA E Mail Address AAAAAAAAAA Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA Phone s433253 ext City AAAAAAAAAA Fax 333s335 State AAAAAAAAAA Zip Code 4 P cone oo a Privacy Policy User Agreement Rev 2012 1 July Page 56 MSPRP User Manual Chapter 7 Account Settings for Account Manager 4 The Corporate Information fields are open for editing Review the details and update the necessary information Then click Continue Note You cannot change the Employer Identification Number EIN Corporate Information An asterisk indicates a required field Corporation Name Business Mailing Address Address Line 1 Address Line 2 City State Zip Code gr Identification Number prececerererecececd Skip Navigation gt Print nis page Help About This Page Privacy Policy User Agreement Field Employer Identification Number EIN Description This 9 digit number cannot be changed or edited Corporation Name The corporation s name is displayed Make any necessary changes to the name Address Line 1 Address Line 2 The corporation s business mailing address is displayed Make any necessary changes to the first line
25. The Account Designee name that was deleted will not be displayed in the list Rev 2012 1 July Page 75 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Listing gt an Help About This Page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individual as a designee Individuals added as designees will receive an e mail notifying them that they have been _ invited to be a designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status x AAAA AAAAA AAA AAA AAA AAA AAA AAA AAAA Cancel 63 Privacy Policy User Agreement Rev 2012 1 July Page 76 MSPRP User Manual Chapter 7 Account Settings for Account Manager Edit Designee Information An Account Manager can edit personal information for Designees in Pending status Account Designees in Pending status have not yet regi
26. View Dispute Claims Listing option The Claims Listing page is displayed The list of claims associated with the Case ID is displayed You can print out the list by clicking Print this page You can dispute claims by selecting the check box next to the Claim Control ID number Then click Continue Skip Navigation Home About This Site CMS Links How To Reference Materials Contact Us Logoff Claims Listing The following are the claims associated to Case ID 99999 99999 99999 Medicare Secondary Payer Recovery Portal Quick Help gt Print this page amp About This Page These claims may also be found on a Payment Summary Form included with the Conditional Payment Letter This listing may differ from the last issued Payment Summary Form if there has been any recent case activity between the date of the Payment Summary Form and the current date Examples of recent case activity include claim disputes or requests for updated conditional payment amounts If you believe any of the claims listed on this screen are unrelated to the case you may request the claims be removed by submitting a dispute below To select a claim for dispute click the checkbox to the left of the claim number When all disputed claims have been marked click the Continue button The next screen will allow you to verify the claims you have disputed and provide any supporting documentation Click Previous will return you to the Case Information page y
27. action allows you to see the list of authorizations currently on file that are associated with the case You will be able to submit new authorizations and upload supporting documentation This action allows you to request the most current information about your conditional payment amount You must request that your account be updated This process will retrieve all additional medical claims and determine what should or should not be associated to the case This action allows you to submit a request for a copy of the original Conditional Payment Letter that was sent out with the current conditional payment amount as displayed on the case information screen View Dispute Claims Listing Provide the Notice of Settlement Information This action allows you to see a list of all medical claims associated with the case This action allows you to enter settlement payment amount fixed percentage options Refer to the sections below for more information about the following actions View Request Authorizations Request an update to the conditional payment amount Request a copy of the conditional payment letter View Dispute Claims Listing and Provide the Notice of Settlement Information Rev 2012 1 July Page 119 MSPRP User Manual Chapter 10 Request Case Access View Request Authorizations Proof of Representation or Consent to Release Selecting this option allows you to view the list of authorizations currently on file a
28. amount as displayed on the case information screen Refer to Chapter 10 Request Case Access Request a copy of the conditional payment letter section The section in Chapter 10 provides the steps to complete this action Skip Navigatio Conditional Payment Request Confirmation Page i awieknep Beneficiary Last Name Assa You have successfully requested an update to the conditional payment amount This request could take 3 to 5 days to complete Please login to the MSPRP Web site to verify that the conditional payment amount has been updated No letter will be mailed Click Continue to return to the Case Information page Privacy Policy User Rev 2012 1 July Page 108 MSPRP User Manual Chapter 9 Beneficiary View Dispute Claims Listing Beneficiary Selecting this option allows you to see the list of medical claims associated with the case The claims may also be found on a Payment Summary Form included with the Conditional Payment Letter This listing may differ from the last issued Payment Summary Form if there has been any recent case activity between the date of the Payment Summary Form and the current date This page allows the Beneficiary to view information about the claims This page is different for Account Managers where only a few fields are displayed For information about Account Managers accessing the View Dispute Claims Listing option refer to Chapter 10 Request Case Access 1 Select the
29. beneficiary information thst was provided during initial registration Click the Continue button to submit the changes Click the Cancel button to return to the Home Page all changes will be lost Account Type Representstive Beneficiary Information Representative Information First Name FIRST MI M Last Name LAST Last Name LAST First Initial F SSN t te HHH PEO E Mail Address AAAA AAA AAA Phone 44484 4884 ext Date of Birth AAAA 4 Fax 364 3HHEJHHHE bianka Representative Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code 432 eae gt Cancel B Privacy Policy User Agreement Rev 2012 1 July Page 65 MSPRP User Manual Chapter 7 Account Settings for Account Manager 5 The Update Account Information Confirmation displays the Account Representative information Click Continue Update Account Information Confirmation The account information has been updated Click the Continue button to return to the Home Page Print this page for your records Account Type Representative Beneficiary Information Representative Information First Name FIRST MIM Last Name LAST Last Name LAST First Initial F SSN eteen a HICN eee E Mail Address AAAA AAA AAA Phone 438K HEH ext Ht Date of Birth AAAA 4 RH ne Gender AAAA Representative Mailing Address Address Line 1 AAAAAAAA Address Line 2 AAAAAAAA Ci
30. box Enter the necessary changes in the provided fields Note You must re enter the E mail address Then click Continue Or click Cancel to return to the Account List page without making any changes Skip Navigation Help About This Page Update Personal Information ES Prin nis page An asterisk indicates a required field First Name i Mi Last Name Email Address Re enter Email Address Phone ext Mailing Address Address Line 1 Address Line 2 City State z Zip Code I oo o tasta e Privacy Policy User Agreement Field Description First Name Enter your first name MI Enter your middle initial optional Last Name Enter your last name E mail Address Enter your personal E mail address Re enter Email Address Re enter your Email Address a second time for verification purposes Phone Enter your personal phone number Ext Enter the extension for your phone number optional Rev 2012 1 July Page 101 MSPRP User Manual Chapter 8 Account Designee Address Line 1 Enter the first line of the company s mailing address Address Line 2 Enter the second line of the company s mailing address optional City Enter the city where the company is located Select the state where the company is located from the drop down list Note To quickly select a state type the first letter to scroll to the desired state State
31. by Medicare After the report has been received by Medicare you can login to the account to maintain account and case information upload and replace documents submit cases and manage Designee access You may choose to manage the entire account or you may invite other company employees to assist as Account Designees This function can be completed without a signed Profile Report on file You may choose to manage the entire account or you may invite other company employees to assist as Account Designees To add Designees to an MSPRP account you must login to the MSPRP site using the Login ID and Password you created during the Account Setup process Chapter 7 Account Settings for Account Manager describes the steps you must take as the Account Manager to invite users to be Account Rev 2012 1 July Page 38 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Designees Chapter 8 Account Designee details the Account Designee self registration process once they have received an invitation E mail from Medicare after you add them to your account Rev 2012 1 July Page 39 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Profile Report Upon completion of all information for the account setup an e mail notification will be sent to the AR listed on the account If you are the AM of a Corporate account or an AM assigned to a Representative account you will receive a copy of the E mail The E mail w
32. have received this transmission but are not the intended recipient you are hereby notified that any disclosure copying distribution or use of the contents of this information is strictly prohibited If you have received this e mail in error please contact the Electronic Data Interchange EDI Department at 646 458 6740 and delete and destroy the original message and all copies 2 The Login Warning page displays detailing the Data Use Agreement DUA Rev 2012 1 July Page 89 MSPRP User Manual Chapter 8 Account Designee Medicare Secondary Payer Recovery Portal CENTERS for SAEONCARE 8 MEDICA SERIES Login Warning S S rint this page UNAUTHORIZED ACCESS TO THIS COMPUTER SYSTEM IS PROHIBITED BY LAW This web site is maintained by the U S Government and is protected by federal law Use of this computer system without authority or in excess of granted authority such as access through use of anothers Login ID and or password may be in violation of federal law including the False Claims Act the Computer Fraud and Abuse Act and other relevant provisions of federal civil and criminal law Violators may be subject to administrative disciplinary action and civil and criminal penalties including civil monetary penalties For site security purposes we employ software programs to monitor and identify unauthorized access unauthorized attempts to upload or change information or attempts to otherwise cause damage In
33. log in to the MSPRP system Password Enter a new password that will be assigned to you the Account Manager Rev 2012 1 July Page 36 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Re enter Password Enter the new password a second time for verification purposes Security Question 1 ee a ene arrow to view the list of security questions Select one question Answer 1 Enter your answer to the security question Make sure to remember this answer Click the drop down arrow to view the list of security questions Select one question to answer Enter your answer to the security question Make sure to remember this answer Command Buttons Security Question 2 Previous Click to return to the previous page Continue Click to save changes and continue to the next page 5 The Account Manager Summary page displays This page lists information that was previously entered during the account setup process All information should be reviewed and verified before continuing Below is a sample Account Manager Summary page Reference Materials Account Manager Summary EN Prim nis page Please review your personal and login Information If you need to change the information click the Edit button If you are satisfied with the information click the Continue button to submit your information Click Cancel to cancel the setup process all data will be lost Please print this page for
34. number and one special character Password must contain a minimum of four 4 changed characters from the previous password Password cannot be changed more than once per day Password must be different from the previous 6 passwords Password cannot contain a reserved word See Help About This Page for a complete list An asterisk indicates a required field Login ID Password Re enter Password The Security Questions allow you to regain account access if you forget your password Please note the answers you provide to these questions should be actus answers and not hints for your password Choose Security Questions and Provide Answers Security Question 1 Please Select Answer 1 J Security Question 2 Please Select Answer 2 A I i 7 a A C A Quick Help i About This Page 4 Using the posted guidelines create a Login ID and Password Then re enter the Password You will need to select 2 security questions and type in the necessary answers Then click Continue This Login ID and Password that you are creating now will be used to enter the MSPRP site and manage the account manage designees create and view cases and upload file attachments The security questions will allow you to access your Login ID and reset your Password in the event you forget either one Description Login ID Enter a new Login ID that you will use when you
35. on the letter received from the EDI Department Enter your Account Manager s E mail address Account Manager s E mail Note If you are registering as the Account Manager for a Corporate account and Address your E mail address is found in the system as an existing user you will NOT be allowed to continue the account setup process Re enter E mail Address Enter your E mail address a second time for verification purposes Command Buttons Previous Click to return to the Account Setup Introduction page Continue Click to save changes and continue to the next page 8 The next page that displays depends on the account ID entered Follow the steps for Account Setup Corporate Information or Account Setup Representative Information in the sections below Rev 2012 1 July Page 31 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Account Setup Corporate After all information has been verified by the system the Account Setup Corporate Information page displays This page displays information entered during the initial registration process 1 Review the listed information and click Continue You can print this page by clicking the Print this page link If any of the listed information is incorrect contact an EDI representative to have it zA f a ok L a corrected Help About This Psge Account Setup Corporate Information gt Print this page Plesse verify t
36. other users to the MSPRP account Cannot update MSPRP account information Can send new case requests for a given MSPRP account Can view cases that they are associated with cases requested by the Account Designee or assigned to the Account Designee by the Account Manager Can update upload documentation to a case that they have been associated with Account Designees can be added removed or deleted by the Account Manager as outlined in Chapter 7 Account Settings for Account Manager Beneficiary Role e Access MSPRP as an authenticated user through MyMedicare Web site Perform Case Actions e Request an update to a conditional payment amount e Request a copy of a conditional payment letter e View Dispute Claims e Send Notice of Settlement e View Case Data with unmasked health care identification number name case ID and date of birth displayed e View Claim Data with unmasked claim number processing contractor provider name diagnosis codes and types of services Login ID and Password Limits Each user of the MSPRP can have only one Login ID and Password Unless previously registered all registrants are directed to the MSPRP URL to register for a Web portal account Users of the Section 111 Mandatory Reporting Application MRA must use that same Login ID and Password to access the MSPRP application Note Login ID and Password fields are case sensitive Also the password can be the same as the password used for the MRA or Worke
37. reviewed Below is a list of documents to be submitted for the case If you d like to delete a document from the list click the Delete link to the right of the document name AMAA PDF Delete Selecting Continue will submit the files to CMS Selecting Cancel will return you to the Case Information page the files will not be submitted to CMS ST Privacy Policy User Agreement Rev 2012 1 July Page 114 MSPRP User Manual Chapter 10 Request Case Access Chapter 10 Request Case Access Request Case Access Corporate and Representative Account Managers can access the Request Case Access link on the portal 1 Login to the MSPRP site through the Welcome to the MSPRP page ogoff Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information snd dispute claims User Name Forgot ID Getting Started Password If you sre a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your Forgot Password MyMedicare account by visiting the MyMedicare gov website at https mymedicare gov For more information refer to How To Get Started under the How To menu option To begin the registration
38. the Welcome page The system then sends you sample E mail below an E mail indicating that your personal information has been changed See Rev 2012 1 July Page 53 MSPRP User Manual Chapter 7 Account Settings for Account Manager Personal Information Update cob msprp cms hhs gov Tue 5 15 2012 1 54 PM AAA AAA AAA AAA PLEASE DO NOT REPLY TO THIS EMAIL Dear First Name Last Name This email is to confirm that your Personal Information on the MSPRP Secure Website has been updated This electronic message transmission is intended only for the person or entity to which it is addressed and may contain information that is privileged confidential or otherwise protected from disclosure If you have received this transmission but are not the intended recipient you are hereby notified that any disclosure copying distribution or use of the contents of this information is strictly prohibited If you have received this e mail in error please contact the COBC Electronic Data Interchange EDI Department at646 458 6740 and delete and destroy the original message and all copies This E mail confirms that your personal information has been updated in the system Rev 2012 1 July Page 54 MSPRP User Manual Chapter 7 Account Settings for Account Manager Update Account Information This page displays the current information on file for the MSPRP account You can update Corporate information such as the corporate
39. to save changes and continue to the next page Click to cancel changes and return to the Designee Listing page 5 The Designee Confirmation page displays with the updated Designee information Click Continue to confirm the changes About This Site Designee Confirmation The following Designee has been successful Designee FirstName AAAA Designee LastName AAAA Designee E Mail them that they have been invited to become a designee on the Account snd may access the Account information by logging into the MSPRP Website If the invited Designee is not currently a registered user please contact the Designee and provide them with passphrase you crested the passphrase is necessary for them to complete registration Click the Continue button to return to the Designee Listing page AAAA AAAA AAA AAA CMS Links How To Reference Materials Quick Help Print this page ly added to the account The designee will receive an email notifying Help About This Page 6 The Designee Listing page is displayed again with the list of designee names Click Cancel to return to the Welcome page Or to edit information for another designee with this Account ID click the designee s last name and follow the steps above Rev 2012 1 July Page 79 MSPRP User Manual Chapter 7 Account Settings for Account Manager Regenerate Invitation E mail When the Account Manager invites a person to be an Account
40. token link will be different from the token provided in the original email Rev 2012 1 July Page 82 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Invitation DoNotReply cob cms hhs gov Thu 5 10 2012 3 58 PM AAA AAA AAA AAA AAA AAA AAA AAA PLEASE DO NOT REPLY TO THIS EMAIL Dear Name You have been invited by First Last for Account ID 99999 to participate in the Medicare Secondary Payer Recovery Portal MSPRP web portal process Please follow this link to register https qua cob cms_hhs gov MSPRP designeeRegistration token pZDiwwMBtwwMbw If you have already registered please visit the Medicare Secondary Payer Recovery Portal Welcome Page at https qua cob cms_ hhs gov MSPRP to login For any questions or problems please contact the person named in the paragraph above This electronic message transmission is intended only for the person or entity to which it is addressed and may contain information that is privileged confidential or otherwise protected from disclosure If you have received this transmission but are not the intended recipient you are hereby notified that any disclosure copying distribution or use of the contents of this information is strictly prohibited If you have received this e mail in error please contact the Electronic Data Interchange EDI Department at 646 458 6740 and delete and destroy the original message and all copies R
41. upload or change information or otherwise cause damage to the web service Use of this system constitutes consent to such monitoring and auditing Unauthorized attempts to upload information and or change information on this web site are strictly prohibited and are subject to prosecution under the Computer Fraud and Abuse Act of 1986 and Title 18 U S C Sec 1001 and 1030 http Awww cms hhs govw About CMS Agency Information Aboutwebsite Security Protocols html Privacy Act Statement The collection of this information is authorized by Section 1862 b of the Social Security Act codified at 42 U S C 1395y b see also 42 C F R 411 24 The information collected will be used to identify and recover past conditional and mistaken Medicare primary payments and to prevent Medicare from making mistaken payments in the future for those Medicare Secondary Payer situations that continue to exist The Privacy Act 5 U S C 552a b as amended prohibits the disclosure of information maintained by the Centers for Medicare amp Medicaid Services CMS in a system of records to third parties unless the beneficiary provides a written request or explicit written consent authorization for a party to receive such information Where the beneficiary provides written consent proof of representation CMS will permit authorized parties to access requisite information Attestation of Information The information provided is complete truthful accurate and meets all requ
42. your records Help About This Page Personal Information Eai Login Information Eai First Name FIRST MI M Login ID AA RRAA Last Name LAST E Mail Address AAAAAAAAAA Phone 3454554 ext HE Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAASAA Zip Code 44 cancel 63 a A Privacy Policy User Agreement 6 Verify that all information is correct To make any corrections click the Edit button next to the proper section to return to that section Once all corrections have been made click Continue at the bottom of Rev 2012 1 July Page 37 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup that page to navigate back to the Summary page After you have returned to the Account Manager Summary page click the Continue button Click Previous to return to the Account Manager Login Information page 7 The Thank You page displays outlining the next steps in the account setup process Reference Materials Thank You Help About This Psge You have successfully completed the Account Setup for the Medicare Secondary Payer Recovery Portal Web site and established yourself as the Account Manager for the Account ID Plesse print this page for your records Next Steps Upon account setup completion you will receive an E mail containing a Profile Report This Profile Report must be signed and then returned to the EDI Help Desk Departme
43. 2 1 July Page 72 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Listing EN Prim Mis page Help About This Page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individusl ss a designee Individuals added as designees will receive an e mail notifying them that they have been invited to be a designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status AAAAA AAA AAA AAA AAA AAA AAA AAAA las capos 6 Privacy Policy User Agreement 10 Click Add Designee to include additional names in the Designee list Or click Cancel to exit this screen and return to the Welcome page To activate a Designee s account refer to Chapter 8 Account Designee To manage case access refer to Chapter 11 Manage Case Access Rev 2012 1 July Page 73 MSPRP User Manual Chapter 7 Account Settings for
44. 3 To delete a designee click the X icon next to the Designee name you wish to remove from the account The Delete Designee Confirmation page is displayed Rev 2012 1 July Page 74 MSPRP User Manual Chapter 7 Account Settings for Account Manager Delete Designee Confirmation a Help About This Page Plesse click on the Continue button to confirm your delete request for this Account Designee This will remove the individual from this Account ID only The Designee will no longer have access to this Account ID but will retain access to any other accounts to which they are currently sssocisted Click on the Cancel button to return to the Designee Listing page without deleting this Account Designee Designee FirstName AAAA Designee LastName AAAA Designee E Mail AMAA AAAA AAA AAA P conve oeo Privacy Policy User Agreement 4 If you DO NOT want to delete the selected Designee click Cancel to return to the Designee Listing page The Account Designee will still be listed and their status will be unchanged 5 If you DO want to delete the selected Designee click Continue The system disassociates the Account Designee from the account The Designee Listing page displays again without the Account Designee who was just deleted This removes the Account Designee from this Account ID only but they will retain access to any other Account ID they are currently associated with The Designee Listing page is displayed again
45. A Last Name AAAAAAAAAA First Initial A Last Name AAAAAAAAAA HICN Ss SSN A SSN HAHH E Mail Address AAAAAAAAAA Date of Birth Phone 555 ext Gender AAAA Fax AA Representative Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AA cone ooo a Privacy Policy User Agreement 4 To make any corrections click Edit next to the proper section to return to that page Once all corrections have been made click Continue at the bottom of that page to navigate back to the Registration Summary page After you have returned to the Registration Summary page click Continue Note Click Previous to return to the Beneficiary Information page 5 The Thank You page displays outlining the next steps in the registration process Rev 2012 1 July Page 24 MSPRP User Manual Chapter 3 New Registration Thank You S nue You have successfully completed the initial registration for the Medicare Secondary Payer Recovery Portal Web site Your assigned Account ID is 11111 Please print this page for your records Next Steps The information captured during initial registration will be vetted to verify the Representative is an appropriate submitter After successful vetting a letter will be mailed to the Account Representative captured during initial registration with your Account ID and PIN Account Setup Upon receipt of the mailed Account ID and PIN the Account Re
46. About This Page Personal Information Ea Login ID Eai First Name FIRST MI M Last Name LAST Login ID AAS55AA E Mail AAA AAA AAA Phone 433 432 4323 ext Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code 2432 cme 63 Privacy Policy User Agreement 10 The Thank You page is displayed You have successfully completed the Designee registration and activation process Click Exit You will return to the Welcome to the MSPRP page where you can log back into the portal The Designee can now login using the credentials you just set up Rev 2012 1 July MSPRP User Manual Chapter 8 Account Designee Designee Thank You Help About This Page You have successfully completed registration for the Medicare Secondary Payer Recovery Portal and established yourself ss a Designee for the Account ID Please print this page for your records Next Steps You may now return to the Medicare Secondary Payer Recovery Portal welcome page login using the Login ID and Password you just aested to access accounts associated with your ID You can visit the Medicare Secondary Payer Recovery Portal Welcome Page st https qus cob cms hhs gow MSPRP or click the Exit button below Privacy Policy User Agreement Rev 2012 1 July Page 95 MSPRP User Manual Chapter 8 Account Designee Account Designee Login 1 Account Designe
47. Account Manager Update Representative Account Information This page displays the current information on file for the MSPRP account You can update the Account Representative s name phone or mailing information You can also replace the existing Account Representative by entering the new Account Representative s information in the Update Representative Information page Some of the Beneficiary information is displayed on this page as well 1 On the Welcome page click the Update Account Information link in the Account Settings box Account Managers only Account Settings Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password 2 The Update Account Information page is displayed Click Edit next to the Representative Information or Representative Mailing Address section The Update Representative Information page displays with all fields open for editing Rev 2012 1 July Page 62 MSPRP User Manual Chapter 7 Account Settings for Account Manager Skip Navigation Quick Help Help About This Page Update Account Information ieee e You may edit the Account Representative personal information or mailing sddress by clicking on the Edit button of that section You may not change the account type or change the beneficiary information thst was provided during initial registration Click the Continue button to submit the changes Click the Cancel bu
48. D and Password for that application and access the portal from the MyMSP section of the Website Beneficiaries are granted full access to their cases and are matched by HICN Rev 2012 1 July Page 4 MSPRP User Manual Chapter 1 Introduction User Roles The MSPRP permits users to take part in the account registration and case function processes Users are defined by one of roles listed below Account Representative AR Role Your Account Representative is the individual who has the legal authority to bind the company to the contract and terms of MSPRP requirements and processing Your Account Representative has ultimate accountability for the company s compliance with MSPRP requirements Although the Account Representative does not have direct access to the MSPRP application and cannot be a user on the portal the Account Representative must approve the organization s profile during the initial account setup and through any subsequent changes The Account Representative is also the recipient of the more severe error notifications such as noncompliance An Account Representative cannot be defined as an Account Manager AM or Account Designee AD for any account The Account Representative e Performs the New Registration step on the MSPRP but is not provided with a Login ID They can NOT be an actual user of the system Designates the Account Manager Must approve the account setup by physically signing the Profile Report inc
49. Designee s personal information open for editing Rev 2012 1 July Page 77 MSPRP User Manual Chapter 7 Account Settings for Account Manager Skip Navigation Update Designee Information Pri nis page Help About This Page Designee Listing page click the Cancel button Plesse click the Continue button to update the information of a potential designee To cancel and return to the An asterisk indicates a required field Designee First Name Designee Last Name Designee E mail Address Re enter Designee E mail Address Passphrase Re enter Passphrase Regenerate token Check this box if another invitstion e mail must be sent to the Designee eat gt Cancel EJ Privacy Policy User Agreement 4 Modify Designee information as needed to correct a name E mail address or change the Passphrase Enter the changes in the appropriate fields You will need to re enter the designee email address and passphrase so all fields are completed Then click Continue Note You can regenerate a token and invitation E mail for the Designee by selecting the Regenerate token box Check this box if another invitation e mail must be sent to the Designee checkbox For more information refer to the Regenerate Invitation E mail section below Field Description The Designee s first name will automatically be displayed Update the Designee s first Designee First Name name if neede
50. Designee for the following account Submitter Information Submitter ID Account Manager Information FirstName MI LastName Phone ext E Mail To set up a Login ID for you to act as a Designee you will need the pass phrase aested by the Account Manager If you do not have the pass phrase please contact the above Account Manager If you have already registered please visit the Medicare Secondary Payer Recovery Portal Welcome Page at https qua cob cms hhs gov MSPRP to login Enter the passphrase You must read the User Agreement provided in the scrolling box To accept the agreement click the checkbox You must accept and agree to the terms of the User Agreement in order to continue through the registration process View and print the agreement below User Agreement THE FOLLOWING DESCRIBES THE TERMS AND CONDITIONS BY WHICH THE CENTERS FOR MEDICARE amp MEDICAID SERVICES CMS OFFERS YOU ACCESS TO THE MEDICARE SECONDARY PAYER RECOVERY PORTAL MPSRP SECURE WEB SITE You must read and accept the terms and conditions contained in this User Agreement avnracch cat mit below end innnarnnratad hw reference hafnra uni mow annece the MOPHP 4 Please check the following box accept the User Agreement and Privacy Policy above P conve ooa a Privacy Policy User Agreement 5 The Designee Registration page informs you that you have been assigned as an Account Designee for the li
51. Edit button of that section You may not change the account type Click the Continue button to submit the changes Click the Cancel button to return to the Home Page all changes will be lost Employer Identification Number EIN 48888HHt cane 3 Account Representative AR dit Information First Name AAAA MI A Last Name AAAA Title AAAA E Mail Address AAAAAAAAAA Phone 444233 ext Fax See Privacy Policy User Agreement 6 Click Continue to proceed The Corporate Information Update Confirmation page is displayed Proceed to Step 10 Or to update the Account Representative information click Edit next to the Account Representative AR Information heading Proceed to Step 7 Rev 2012 1 July Page 58 MSPRP User Manual Chapter 7 Account Settings for Account Manager 7 The Update Account Representative AR Information page is displayed The fields are open for editing Make any necessary changes Note You must re enter the Account Representative s E mail address in the Re enter E mail Address field Then click Continue POTS fer MEDAME G NOMAD CTS An asterisk indicates a required field AR First Name AR Title Update Account Representative AR Information Reference Materials ontact Us Help About This Page Logoff gt Prim mis page MI Last Name E mail Address Re enter E mail Address Phone Fax ext
52. Make sure to remember this answer Command Buttons Click to return to the Designee Personal Information page Continue Click to save changes and continue to the next page Rev 2012 1 July Page 93 MSPRP User Manual Chapter 8 Account Designee 9 The Designee Summary page is displayed This page provides a summary of all the information you have entered To make any corrections click the Edit button next to the proper section to return to that section Once all corrections have been made click Continue at the bottom of that page The Designee Login Information page is displayed again You must enter and re enter the Designee s assigned password Then click Continue to navigate back to the Designee Summary page To change the Login ID click Edit next to the Login ID field You will be returned to the Designee Login Information page You can change the Login ID in the field provided You will need to enter and re enter the password in the fields Then click Continue After you have returned to the Designee Summary page click the Continue button Designee Summary gt Print nis page Please review your personal and login Information If you need to change the information click the Edit button If you sre satisfied with the information cick the Continue button to submit your information Click Cancel to cancel the setup process all dats will be lost Please print this page for your records Help
53. N that has already successfully completed the registration process for Corporate account types Change the EIN and continue the registration process Previously Used SSN During initial registration an error message will display on the Representative Information or Beneficiary Information page if you enter an SSN that has already successfully completed the registration process for Representative account type If you have incorrectly entered your SSN on this page change the SSN entered and continue the registration process Registration Denied During initial registration an error message will display if a beneficiary entered for Representative account type is not found in the database Registration cannot be completed for this beneficiary Unsuccessful Account Setup Account PIN Error The Personal Identification Number PIN for the Account ID will be sent to you for Representative accounts or the Account Representative for Corporate accounts after the New Registration step has been completed If during Account Setup the Account Manager receives an Invalid Account ID PIN Combination error message check the numbers on the mailing received An Account ID should always contain nine digits and a PIN should have four digits If your numbers are shorter add leading zeros to make them the proper length You have three tries to enter the PIN correctly before the account is locked Contact an EDI representative to confirm the Account ID PIN c
54. RDING amp LIMITING ACCESS TO DATA the undersigned Account Manager for the MSPRP representative account defined above certify that the information contained in this Registration is true accurate and complete to the best of my knowledge and belief and authorize CMS to verify this information agree to establish and implement proper safeguards against unauthorized use and disclosure of the data for the purposes of MSPRP proposal s review and processing Proper safeguards shall include the adoption of policies and procedures to ensure that the data obtained shall be used solely in accordance with Section 1106 of the Social Security Act 42 U S C 1306 Section 1874 b of the Social Security Act 42 U S C 1395k b Section 1862 b of the Social Security Act 42 U S C 1395y b and the Privacy Act of 1974 as amended 5 U S C 552a Users shall establish appropriate administrative technical procedural and physical safeguards to protect the confidentiality of the data and to prevent unauthorized access to the data provided by the CMS You agree that the authorized representatives of the CMS shall be granted access to premises where the Medicare data are kept for the purpose of inspecting security arrangements and confirming whether the user is in compliance with the security requirements specified above Access to any information exchanged during the MSP Recovery process shall be restricted to CMS COBC and MSPRC personnel and other authoriz
55. aeecaeenaeenaeeeaeens 7 Chapter 2 About the Welcome to the MSPRP Page cccsscssceesseeseeessecsseceseceseceseceseeeeeeseeseaeseneeeaeeeaeeeaaeenaes 8 About the Navigation Ment isicisc tecsaveladtivesedecevess ieteosi ea EE EE E E EGE E TEE OER 9 About the Bulletin Board sronirduieirieiienesriir ioris e Ee iA AA ER Epi E OESE RARER 9 About the New Registration Button eeceeeesseeeseeeseeeeecsseceaecesecsseesseeeseeseeeecaeeeaeeeaeecaaecaaecaeseaeenaeee 10 About the Account Setup BUON wicisnischeisacazeseasdacessnagenedsnaietenssnduederasdedisseadeadeboanedielasecialetacdedeebaaswetdbantetites 10 About the Sign In To Your Account Fields ee eee esceesseeseeesseceseceseceseeseeeseesseeseaeecaeeeaeecaaecaaecaeenaeenaeens 10 Chapter 3 New Registration Step 1 0 cee ceeeeceeeceeseeeeeeseecaecaecaecesecssecsseeeseeseneseaeeeaeeeaeecaaecaaeceaesaeeaeen 12 Registration Steps for All Account Types eee eceesceeseeessecssecsseceseceseceseeeeeeeseeecaeeeaeecaeeeaaecaaecaeenaeeaeens 13 Corporate Account Dy pes sccscssssevaes deca es0s dansecbassiest AE E E a e A weet o aaa E 16 Representative Acc unt Types iaccssisscctesissacds sncpborssatenpecscnsevonssearessaashanca soigedicssnsveuveascupdesassbens salsosesesatonren 21 Beneficiary issii cgeccudeedsvedsn uses tees sayedis caveevas sasheddbcusciiasi capetascguaveasccsyea R aa i ai aa aia 27 Chapter 4 Account Setup Step 2 vesissssssediacctvesl selves testes inssiva tenetes nasveeee esis sieev
56. al Enter the city where your company is located Select the state where the company is located from the drop down list Note To quickly select a state type the first letter to scroll to the desired state Zip Code Enter the company s zip code required plus 4 digit zip code suffix optional Command Buttons Click to return to the Account Setup Intro page Click to save changes and continue to the next page State Rev 2012 1 July Page 92 MSPRP User Manual Chapter 8 Account Designee 7 The Designee Login Information page displays Setup a Designee Login ID and Password and select 2 security questions Enter the required information and click Continue About This Site CMS Links How To Reference Materials Contact Us Designee Login Information The security information requested on this page will allow the system to authenticate your identity each time you log Help About This Page on This will ensure only you sre provided the access and updating priviledges restricted to an Account Designee Choose your Login ID and password carefully Login IDs must be 7 characters Login IDs must be unique within the system Login IDs must be in the format of AA999AA first two alphabetic next three numeric last two alphabetic Password must be changed every sixty 60 days Password must consist of at least eight 8 characters Password must contain st least one upper case letter one lower case letter
57. al a A v Skip Navigatio Logoff Home About This Site CMS Links How To R als Contact Us Authorization Documentation Upload Print nis page Help sbout this page Please type in the document name or click browse to find the document The document must be in PDF format and the size limit is 40 MB megabyte per document for attachments Selecting Continue will upload the documents Selecting Cancel will return you to the Authorization Documentation page and documents will not be uploaded P cone oo Privacy Policy User Agreement Rev 2012 1 July Page 122 MSPRP User Manual Chapter 10 Request Case Access Sample document Submit New Authorization An asterisk indicates a required field Select the authorization type Consent to Release What is Consent to Release Proof of Representation What is Proof of Representation Please click the Help about this page link to view the descriptions of these authorization types Please select from one of the following which best describes the representation type Attorney Start Date of I MM DD CCYY Authorization End Date of Authorization I MM DD CCYY Optional Supporting Documentation is Required Please refer to Help About This Page to identify what documents should be submitted 4 Upload Documentation To upload supporting documenation please click here Below is a list of documents to be submitted for the case If y
58. annot also be an Account Representative AR The AM and AR named during New Registration must be different individuals The AM cannot be an AM or AR on any other MSPRP account To access the MSPRP this step Account Setup must be completed for each MSPRP account You can perform this step after you receive your letter with the PIN assigned to the Account during Step 1 New Registration You must have the Account ID PIN and your complete Account Manager information on hand Partial account setup requests cannot be saved and completed at a later time Corporate Account Types Upon receipt of the mailed Account ID and PIN the Account Representative AR must provide the information to the designated Account Manager AM The AM needs to access the MSPRP to complete the account setup process Representative Account Types Upon receipt of the mailed Account ID and PIN the Account Representative AR can provide the information to a designated AM or you can assign yourself to the AM role The AM must then access the MSPRP to complete the account setup process Account Setup Steps for All Account Types The following section details the information that must be entered by the Account Manager Contact the EDI Department if you have any questions or problems regarding the Account ID at any time during account setup Account Setup requires the entry of the Account ID and Personal Identification Number PIN received from the mailing after r
59. are unrelated to the case you may request he claims be removed by submitting a dispute below To select a claim for Gispute click he checkbox to the left of the claim number When ali disputed claims have been marked click the Continue duton The next screen will alow you to verify the claims you have disputed and provide any Supporting documentation Click Previous wil retum you to the Case information page your dispute selections will be lost Click Cancel will retum you to the Home Page Note If the checkbox next to he claim number is disabled the daim may not be disputed Claims Dispute Claim Control ID CN el Total Charges Reimbursed Amount Conditional Payment wl sess 9999999 1 205 00 77 05 77 05 Fi m 9999999 2 165 00 56 09 56 09 ene 9999999 3 40 00 9 94 9 94 eveceeve 9999999 4 84 00 26 45 26 45 ee99 99999999 1 1 365 00 327 56 327 56 3 The Claims Dispute Verification page is displayed The list of claims that are being disputed is displayed You can enter a statement about why the claims are being disputed by entering text in the Supporting Information amp Documentation text box Rev 2012 1 July Page 130 MSPRP User Manual Chapter 10 Request Case Access 4 If necessary upload supporting documents for the disputed claim by clicking the Upload Documeniation link Note The document must be in Adobe Acrobat pdf format Claims Dispute Verification RN EAN Below is 3 list
60. ase Listings View Account Activity and Help About This Page 1 The Request Case Access link will allow you to add a new case to this MSPRP account Click Request Case Access Welcome Account 99999 AAA AAAA The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims View Account Activity You may view the account activity by clicking the appropriate link under the Account Settings To request information regarding a case you have not already associated to your account click the Request Case Access link below To see cases that you have previously sssocisted to your account click the Case Listing link below Request Case Access Case Listing Privacy Policy User Agreement 2 The New Case Request page is displayed Continue to the New Case Request section in Chapter 10 Request Case Access to proceed with requesting case access Rev 2012 1 July Page 98 MSPRP User Manual Chapter 8 Account Designee View Account Activity Click View Activity Account from the Account Settings box This page allows you view account activity Refer to the View Account Activity section in Chapter 7 Accounts Settings for Acco
61. ase information please login to your ae Forgot Password MyMedicare account by visiting the MyMedicare gov website st https mymedicare gow For more information refer to How To Get Started under the How To menu option To begin the registration process Login iea click the New Registration button STEP 1 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement Rev 2012 1 July Page 29 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup 6 The Account Setup Introduction page displays This page describes what steps you will be taking in the account setup process and informs you of your duties as the Account Manager Read the introduction and then click Continue to proceed with the account setup process Medicare Secondary Payer Recovery Portal oe oN a p Help About This Page Account Setup Introduction You have selected a link that guides you through the process of establishing a new Account Manager ID for the Medicare Secondary Payer Recovery Portal MSPRP Please have your Account Identification Number and Personal Identification Number PIN available The Account ID and PIN are listed on the mailing thst was sent to the contact for the account This would be the Account Representative for a corporate account type and the Representative for a representative account type If you sre already associated with an account on the MSPRP you
62. at describes the nature of injury illness Beginning date of the Date Of Service for the claim To Date End date of the Date of Service for the claim Total Charges Total charges submitted by the Provider for the claim Reimbursed Amount Amount reimbursed to the Provider for the claim Conditional Payment The amount conditionally due by the debtor Command Buttons Previous Click to return to the Case Information page Your dispute selections will not be saved Continue Click to save changes and continue to the next page Cancel Click to return to the home page 2 The Claims Dispute Verification page is displayed Rev 2012 1 July Page 110 MSPRP User Manual Chapter 9 Beneficiary 3 If necessary you can enter a statement about why you are disputing the claim in the provided Supporting Information amp Documentation text box You can enter up to 500 characters in this box Additionally you can upload supporting documents for the disputed claim by clicking the Upload Documeniation link Note The document must be in Adobe Acrobat pdf format Then click Continue If you DO NOT need to upload additional documentation click Continue The Claims Dispute Confirmation page is displayed Claims Dispute Verification pee Help About This Page Below ts a list of daims associated to Case ID 99999 99999 99999 ou have selected for dispute please review for acc
63. authorization levels Once NOS information is provided the MSPRC will move towards issuing a Demand Or Bill based on the option selected This option is not available if there is a bankruptcy on file for the case or if the case is in one of the following statuses Claim Retrieval Demand Bill Issued Closed Rev 2012 1 July Page 141 MSPRP User Manual Chapter 10 Request Case Access Case Listing 1 Login to the MSPRP site through the Welcome to the MSPRP page using your Account Manager Login ID Enter your User Name and Password in the fields provided Then click Login Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and User Name provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid i authorization request an update conditional payment amount submit settlement information and dispute claims Forgot ID Getting Started Password If you are a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your MyMedicare account by visiting the MyMedicare gov website at https mymedicare gow Forgot Password For more information refer to How To Get Started under the How To menu option To begin the registration process Login Cleat click the New Registration button STEP 1 New Registration Account Setup Account ID and PIN
64. count Representative e Manages the MSPRP account s profile information and updates general account information e Sends new case requests for the MSPRP account they are associated with Rev 2012 1 July Page 5 MSPRP User Manual Chapter 1 Introduction e Can view information for all cases they are associated with based on each MSPRP account e Can invite other users to function as Account Designees AD e Can grant add an Account Designee to a case e Can revoke remove an Account Designee s access to cases and or an entire MSPRP account To replace an Account Manager the Account Representative for Corporate or Representative accounts must contact the EDI Department Account Designee AD Role At the organization s discretion an Account Manager for Corporate or Representative account types may invite other individuals known as Account Designees AD to have access to the MSPRP for the Account Manager s account Corporate accounts may have up to 20 Account Designees associated with one MSPRP account Representative accounts may have up to 5 The Account Designee Must register on the MSPRP and obtain a Login ID and Password Can be associated with multiple MSPRP accounts but only if invited by the Account Manager for those accounts Can change their personal information on the MSPRP Cannot be an Account Representative for any MSPRP account Cannot be the Account Manager for the same MSPRP account Cannot invite
65. covery claim With the use of this portal you may submit a valid suthorizstion request an update conditions payment amount submit settlement information and dispute claims If you would like to login to the MSPRP system agsin please click the link below Login to MSPRP Ifyou sre a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your MyMedicare account by visiting the MyMedicare gov website at https mymedicare gov Privacy Policy User Agreement 3 Once this is displayed you can close your browser Account Managers Account Representatives and Designees can log back into MSPRP by clicking the Login to MSPRP link Beneficiaries will need to log back in through the MyMedicare portal Rev 2012 1 July Page 149 MSPRP User Manual Chapter 13 Troubleshooting Chapter 13 Troubleshooting Replace Account Representative Use the Edit button on the Update Corporate Information page as accessed from the Account Settings box on the Welcome page See Chapter 7 for more information Replace Account Manager If an Account Manager must be replaced for Corporate accounts the Account Representative must contact the EDI Department and request replacement AMs cannot be replaced using the MSPRP site Unsuccessful Account Registration Previously Used EIN During initial registration an error message will display on the Corporate Information page if you enter an EI
66. d The Designee s last name will automatically be displayed Update the Designee s last Designee Last Name name if needed The Designee s E mail address will automatically be displayed Update the E mail Designee E mail Address address if needed Rev 2012 1 July Page 78 MSPRP User Manual Chapter 7 Account Settings for Account Manager Re enter Designee E mail Address The Designee s E mail address will not be displayed in this field You will need to re enter the Designee s E mail address for verification purposes Make sure that this E mail address is the same as the E mail address entered into the field above Passphrase Re enter Passphrase Regenerate token Check this box if another invitation e mail must be sent to the Designee The Designee s passphrase will automatically be displayed Update the passphrase if needed Note If you change this passphrase you will need to notify the Designee of the new passphrase so the user can log in The Designee s passphrase will not be displayed in this field You will need to re enter the Designee s passphrase for verification purposes Make sure that this passphrase is the same as the passphrase entered into the field above Select this checkbox to regenerate the token and invitation email This information will be sent to the Designee for login to MSPRP Command Buttons Continue Click
67. d account set up on the Web site www cob cms _hhs govw MSPRP including the Registration Process notice and applicable user guides Next Steps To complete the account setup your designated Account Manager should be selected and provided with your MSPRP Account ID and Personal Identification PIN MSPRP Account ID 999999999 PIN 9999 The Account Manager should return to the Medicare Secondary Payer Recovery MSPRP at https www cob cms hhs gov MSPRP and select the Account Setup button If you have any questions or concerns please contact your assigned EDI Representative Phone 646 458 6740 Email COBVA GHIMEDICARE COM Sincerely Medicare EDI Department Beneficiary Beneficiaries will access the portal through the MyMedicare web site at https mymedicare gov Refer to Chapter 10 Beneficiary for more information Rev 2012 1 July Page 27 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Chapter 4 Account Setup Step 2 This section describes Step 2 of the MSPRP registration process Account Setup This step can be performed by the Account Manager AM The Account Manager for the MSPRP Account will need to provide personal information including Account ID Personal Identification Number PIN and E mail address in the Account Setup page You will be able to setup your login ID during this process For Corporate Only The Account Manager for Corporate account types c
68. d documents io CMS Selecting Previous wilt retum you to the View Dispute Claims Listing page Selecting Cancel will return you to the Case information page all changes will be lost and the documents will not be submitted to the MSPRC Cs BY we Rev 2012 1 July Page 131 MSPRP User Manual Chapter 10 Request Case Access 2 The Dispute Claims Documentation Upload page is displayed Skip Nawgatior Dispute Claims Documentation Upload Pea pege Help about tvs page Please click browse to find the Gocument The document must de in POF format and the size limit ts 40 MB megabyte per document for attachments Selectng Continue will upload the documents Selecting Cancel will retam you to the View Dispute Claims Listing page and documents will not be uplosded Browse Ponas Browse __ Cancel E3 3 Click Browse to locate the document you want to upload Note The document must be in Adobe Acrobat pdf format Then click Continue The Claims Dispute Verification page is displayed again The document you uploaded will be listed Note To delete uploaded documents click on the x next to the document name The document will be removed from the supporting documentation list 4 Click Continue confirm submission The Claims Dispute Confirmation page is displayed Rev 2012 1 July Page 132 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal
69. d return to the prior page Rev 2012 1 July Page 71 MSPRP User Manual Chapter 7 Account Settings for Account Manager 8 After clicking Continue the Designee Confirmation page displays indicating that the invited Designee has been sent an E mail notifying them that they have been added to this Account ID They must use the token link in that E mail in addition to the Passphrase you provide them to register for the MSPRP and access this Account ID Skip Navigation Designee Confirmation eee Quick Help Help About This Page The following Designee has been successfully added to the account The designee will receive an email notifying them thst they have been invited to become a designee on the Account and may access the Account informstion by logging into the MSPRP Website If the invited Designee is not currently s registered user please contact the Designee and provide them with passphrase you crested the passphrase is necessary for them to complete registration Click the Continue button to return to the Designee Listing page Designee First Name AAAA Designee LastName AAAA Designee E Mail AAAA AAA AAA Privacy Policy User Agreement 9 Click Continue to go to the Designee Listing page The new Designee is listed with the status of Pending Note The invitation E mail will come from cobva ghimedicare com Inform your Designee to allow Email deliveries from this address Rev 201
70. e MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims Forgot ID Getting Started Password If you are a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your 2 Forgot Password MyMedicare account by visiting the MyMedicare gov website st https mymedicare gov For more information refer to How To Get Started under the How To menu option To begin the registration process Login iea click the New Registration button STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement Rev 2012 1 July Page 8 MSPRP User Manual Chapter 2 About The Welcome to the MSPRP Page About the Navigation Menu The navigation menu at the top of each page provides additional details about logging in to MSPRP accessing CMS links and EDI contact information A Skip Navigation Reference Ms Navigation Menu Home Navigates back to the Home Welcome page from any other page in the portal Navigates to the How to Use This Site link offering general information on how to use the MSPRP application CMS L
71. e a note of your Account ID or use the Print this page link to print this information Thank You gt Print nis page You have successfully completed the initial registrstion for the Medicare Secondary Psyer Recovery Portal Web site Your assigned Account ID is 11111 Please print this page for your records Next Steps The information captured during initial registration will be vetted to verify the Representative is an sppropriste submitter After successful vetting a letter will be mailed to the Account Representative captured during initial registration with your Account ID and PIN Account Setup Upon receipt of the msiled Account ID and PIN the Account Representative will be instructed to have the sppropriste Account Manager return to the Medicare Secondary Payer Recovery Ports Web site to complete the account setup The Account Manager will need to enter the Account ID and PIN on the Account Setup page to begin setup Privacy Policy User Agreement 6 Click Exit to return to the Welcome to the MSPRP page Rev 2012 1 July Page 19 MSPRP User Manual Chapter 3 New Registration Next Steps Within two weeks a letter will be mailed to you the AR that contains the Account ID and PIN along with instructions for setting up the account to be completed by the Account Manager If a letter is not received within 10 business days contact the EDI Help Desk Once the Account Manager AM has completed the account setu
72. e of case is displayed Rev 2012 1 July Page 106 MSPRP User Manual Chapter 9 Beneficiary The status of the case is displayed There are 7 different status c S types In Development Open Claim Retrieval Demand Bill ASe SIAU Issued and Closed For more information refer to the section Help About This Page Case Information below The date the Rights and Responsibilities was sent out is Rights and Responsibilities Letter Mail Date 9 P displayed Beneficiary Medicare Number Beneficiary Medicare number Beneficiary DOB Beneficiary date of birth Beneficiary Last Name Beneficiary last name Date that the conditional payment letter was sent out to the Conditional Payment Letter Mail Date requestor The current conditional payment amount that the debtor owes Current Conditional Payment Amount Note You can request an Update to the conditional payment amount so the most recent amount is displayed on the screen Conditional Payment Amount was updated on Last date the conditional payment amount was updated There are two types of authorization levels Proof of Authorization Level Representation POR and Consent to Release CTR For more information refer to the section Help About This Page Case Information below This field describes the status of your authorization level There are 3 status types available Verified Unverified and Invalid For more information refer to the section
73. e seid vein elven eaeeiearoeess 28 Account Setup Steps for All Account Types cee ceseescecssecssecsseceeceseceeeeseeeseescneeeaeesaeesaaecaaecaesaeenaeens 28 Account Setup Corporate e ce cescesecsseceseceseceseeesseeeseeeaeeeseeesaecsaecsaecsaecsaecsseesseeseeesseeseneseneeeneeeaeeeaaes 32 Account Setup Representative oo ee eeceeseeseeseecseecnsecesecesecsseesseeeeeeseesseeseaeecseesaeeeaaecsaecaaecaeseaeeaeens 33 Account Manager AM Setup scescccscehscvesscey sutgset leucusdiedsebvabasuves ace caagbiadeashediadebdyeboqued tess DEEE EEES 34 Profile Report ssi itis teddies sivas teivasivilieea a aa lei N thine eiassielendiniiens 40 Chapter 5 Login to the MSPRP Site scisiesscvcaccissiceseevteacssetatinsseeasdciun i ccteesesdacoetslaniveacscieubsteotessbaadetelasntsensy 42 Account Manager LO oni sepeser paneon E E E E E EES E EET 42 Forgot User Name Login ID oo eee eeceseeeeeeeeeeeseeeseecsaecaeceaecaecsaecsseeeseeeseeseaeecaeeeaeeeaaecaaecsaeeaeeaeen 44 Forgot PASS WOE sitcdsu fs sth see oessua cary ce toseugussacestsstatessstyeresut hehe EAE PESE REE EEEE R EEE aaie EEE E ENa 47 Chapter 6 MSPRP Welcome Page after Successful Login cee ceeceeeceeeceseeeseeeeeeeeaeeeaeecaaecaesaecnaeenaeens 50 About The Welcome Home Pape iscsi scics pcacecdsasesessccsteasbecseredeicustanssceveneidecovdssausestaescestlassctvebenscsseussacdenss 50 Chapter 7 Account Settings for Account Managet sssceessecssecsseceseceeeeseeeseeeeeeeca
74. e your Login ID request is processed The e mail will contain your Login ID Please note The e mail message will be sent from a notification only sddress thst cannot accept incoming e mail Plesse do not reply to it If you do not receive your e mail within 24 hours please call the EDI Help Desk Department st 646 458 6740 EDI Representatives are available to assist you Monday through Friday excluding Federal holidays from 9 00 a m to 5 00 p m Eastern Time Medicare Secondary Payer Recovery Portal Welcome Page Privacy Policy User Agreement 5 Click the Medicare Secondary Payer Recovery Portal Welcome Page link to return to the Welcome to the MSPRP page You will receive an E mail containing your Login ID After receipt of the E mail return to the MSPRP site and log in using your Login ID and Password If you do not receive an E mail within 24 hours contact an EDI representative Rev 2012 1 July Page 46 MSPRP User Manual Chapter 5 Login to the MSPRP Site Forgot Password If you forgot your password to log in to the portal follow the steps below 1 On the Welcome to the MSPRP page click Forgot Password below the Password field Password Forgot Password 2 This displays the Forgot Password page Enter your Login ID and click Continue Or click Cancel to stop and return to the Welcome to the MSPRP page without requesting a temporary password S s a Forgot Password An asteris
75. ed users who require access to 1 perform their official duties in accordance with the approved uses of the information 2 respond to authorized law enforcement investigations or 3 respond to any required legal process Such personnel shall be advised of 1 the confidential nature of the information 2 safeguards required to protect the information and 3 the administrative civil and criminal penalties for noncompliance contained in applicable Federal laws Signature of Account Manager Date Rev 2012 1 July Page 41 MSPRP User Manual Chapter 5 Login to the MSPRP Site Chapter 5 Login to the MSPRP Site Account Manager Login Since the New Registration and Account Setup steps have been completed the Account Manager Corporate or Representative can now log in to MSPRP Note This login process does not apply to beneficiaries who access the portal through MyMedicare Designees will be able to login to the site after they register on the MSPRP via an invitation E mail received from an AM 1 Enter the following URL into your Web browser https www cob cms hhs gov MSPRP 2 The Login Warning page displays detailing the Data Use Agreement DUA Review the DUA To proceed click the Accept link at the bottom of the page You will be denied access to the MSPRP site if you click I Decline The Welcome to the MSPRP page displays Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a q
76. eeeaeeeaeecaaecaaecaecnaeeeaeen 31 Update Personal Information sissies ceisiai enert sp ae E ENE REE EES EE Ea Ea a a aA 31 Update Account Information eee eeceseeeeeesseeeseeeseecsaecsaecaecaecssessaeeeseeeeeeesaeeeaeeeaeecaaecaaecsaesnaeeaeens 55 Update Corporate Informa tonsa ioccccessteicessnapssessotsnsecscosecconspeasessaaghanca soagedidssnsvenveascetdeead beas sadnceesbentoonns 55 Update Representative Account Information 0 0 ce eeceesecesecesecseeceseeeeneeeeeeeaeeeaeeeaeecaaecaaecaaecaeseaeenaeens 62 De sipned Mamtenance iii sieeve ieserdeetieveastelivesl ss EEE EEEE EEE E E 67 Adda Designe toan Acoute s aitaisinaiatiniiidai amici amen iaieaien i nannahen iin 67 Delete a Designee from an ACCOUMNE ee eeeesceesecnsecnseceseceseceseceseceseeeeeeeeeeseaeecaeesaeecaaecsaecaaecsaeseaeeaeees 74 Edit Designee Information 20 0 0 cece eeseceseceseceseceseeeseeeeneeeaeeeseeesaecsaecsaecsaecsaecsaeesseeseeseeeseneeeneeeaeeenaeenaes 77 Regenerate Invitation E mail x sccstccscphecveshcas satgiset leucusdiedsebvabastvetace caagbiadeassbdiadoblysboques ives DEEE ERE ENESE 80 View Account ACUVItY eec e a a a e thivebil eiacselensiaieds 84 Change Password issii airaa a EAEE EN Eaa ETENEE S EEAS 86 Chapter Acc nt Desi Ste aerisire n i EEEE EE E O E EE EEEE E E E 88 Account Designee Registration and Activation s sesesssessssesirsresttsresrsresttsstsrisseestnstestestesestenseesrssrest 88 Account Desisnee Lo Sims erdiiece kideen i so
77. egistration To successfully set up the MSPRP account and register as the Account Manager follow the steps outlined below 1 Enter the following URL into your Web browser https www cob cms hhs gov MSPRP 3 The Login Warning page displays detailing the Data Use Agreement DUA Review the DUA To proceed click the Accept link at the bottom of the page You will be denied access to the MSPRP site if you click I Decline The Login Warning page may be printed by clicking the Print this page link in the upper right side of the page 4 The Welcome to the MSPRP page displays Rev 2012 1 July Page 28 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup 5 Click Step 2 Account Setup The AM for the Account ID must complete this section For Corporate accounts this will be the individual assigned AM duties by the AR For Representative Accounts this can be the AR or an individual assigned AM duties by the AR Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and User Name provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid OO authorization request an update conditional payment amount submit settlement information and dispute claims Forgot ID Getting Started Password If you sre a Medicare Beneficiary and would like to use the MSPRP to request c
78. equest for an updated conditional payment letter or amount All authorized entities will receive a copy of the letter This request can take 7 10 business days You will need to login to MSPRP again and view your account to see if the information has been updated 1 The Conditional Payment Request Confirmation Page is displayed after you select the option from the Case Information page Click Continue Conditional Payment Request Confirmation Page i gt Case ID sees sees ssm Beneficiary HICN see Beneficiary Last Name Assa Help About This Page You have successfully requested an update to the conditional payment amount This request could take 3 to 5 days to complete Please login to the MSPRP Web site to verify that the conditional payment amount has been updated No letter will be mailed Click Continue to return to the Case Information page Privacy Policy User Agreement 2 The Conditional Payment Letter Confirmation Page is displayed Rev 2012 1 July Page 128 MSPRP User Manual Chapter 10 Request Case Access P ___ Conditional Payment Letter Confirmation Page oe er fl i Cave i 20771 OR D Benetin HACE EEA iiaia Deceticaary Lant Meme varsta Yow fave successiay requettes he generabon of Pe comabonal pament hete Tris request cada tate J to aam to con etete ORO Poe Protos DANA te Hehe te he Cane PANTINA bape CIO Da Continue DIN M AN WM Hine Page 3 Cl
79. er gathering all necessary information before beginning the registration process It is critical that you provide accurate information during the registration process Documents available on the MSPRP under the How To link provide detailed information to assist you The How to Get Started on the Medicare Recovery Portal MSPRP document contains information for both New Registration and Account Setup including determining your account type and identifying the roles of users for the MSPRP The Medicare Secondary Payer Recovery Portal MSPRP Registration Guidelines and Scenarios will further assist you with your registration and Account Setup decisions The information provided on a user s association to a case authorization and mailing address rules as well as Registration and Account Setup scenarios will help ensure accuracy during these processes Attorneys and Third Party Payers TPAs especially will find the scenarios helpful For Corporate Accounts This representative is registering as a corporate entity with an Employer Identification Number EIN Those registering as a Corporate account type will regularly submit MSPRP requests You will need the following information e The Employer Identification Number EIN Taxpayer Identification Number TIN for the company company name and mailing address e Account Representative contact information name job title address E mail address phone number For Representative Accounts Thi
80. es can login to the MSPRP site through the Welcome to the MSPRP page Enter your Login ID in the User Name field and your Password in the Password field Then click Login Sign in to your account Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an updste conditional payment smount submit settlement information and dispute claims Forgot ID Getting Started Password If you sre a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your 5 E 3 z Forgot Password MyMedicare account by visiting the MyMedicare gov website at https mymedicare gov For more information refer to How To Get Started under the How To menu option To begin the registration process Losin Clea click the New Registration button STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement 2 The Account List page displays You are now logged in to the MSPRP system Rev 2012 1 July Page 96 MSPRP User Manual Chapter 8 Account Designee The Account List page is the Account Designee s home page This page functions as the main processing page to initiate any MSPRP functions available to you as the Designee He
81. esignee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individual as a designee Individuals added as designees will receive an e mail notifying them thst they have been invited to be a designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mailAddress Passphrase Status Privacy Policy User Agreement 4 This page allows you to print the Designee names assigned to the account Click the Print this page link in the upper right corner Or to return to the Welcome page without making any changes click the Cancel button 5 To add an Account Designee click Add Designee in the Designee Listing page The Designee Information page displays Note To update Designee information refer to the Edit Designee Information section below Rev 2012 1 July Page 68 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Information gt rint this page Help About This Page Please click the Continue button to check the E Mail Address of a potential designee To cancel and return to the Designee Listing page click the Cancel button An asterisk indicates a required field We ask for the E mail address to verify if the person is currently a re
82. ess in this New Registration step and NOT the E mail address for users of the MSPRP For Corporate accounts only ARs of Representative accounts are permitted to be users of the MSPRP Refer to Chapter 3 New Registration Step 1 for more information on account registration STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required About the Account Setup Button After completion of the New Registration step Medicare will mail a confirmation letter containing the Account ID and PIN to the Account Representative along with instructions for setting up the account The assigned Account Manager can perform the second step to setup the account Click Step 2 Account Setup to continue the account setup process using the Account ID and PIN The Account Manager will also register as the Account Manager at this time For Corporate accounts the Account Manager receives the Account ID and PIN from the Account Representative Refer to Chapter 4 Account Setup Step 2 for more information on account setup and Account Manager registration STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required About the Sign In To Your Account Fields After Account Managers and Account Designees have self registered and after Account Managers have completed the Account Setup process the Account Managers and Account Designees can login to the portal using their Login IDs and Passwords in the Accou
83. etail information click the case number To manage Designee access to the case click on the Manage Access link To perform a search enter he search criteria and click the search bution ReMAS Case I0 Beneficiary HICN oR Beneficiary SSN Search Selecting Cancel will return to the Home Page Cases ReMas Case ID Bene Last Name Bene HICN SSN Bene Date of Birth Case Access 9999999999 999 AAAA a SS Manage Access 9999999999 999 AAAA 5 m Cancel ER Privacy Policy User Agreement 4 This page displays all cases associated with your Login ID You can view the case detail information by clicking on the recovery Case ID displayed This page also allows you to search for specific cases by providing search criteria You must enter information in at least one of the fields ReMas Case ID Beneficiary HICN or Beneficiary SSN Click the Search button to perform the case search Field Description ReMas Case ID Recovery case identification number Enter the case number to search for case details Beneficiary HICN Enter the Medicare number for the beneficiary on the case as entered when the case was created Enter the social security number for the beneficiary on the case as entered when Beneficiary SSN the case was created Command Buttons Cancel Click the Cancel button to return to the Welcome page Rev 2012 4 July age 144 MSPRP User Manual Chapter 11 Manage Case Access Cha
84. ettlement information and dispute claims PEE Account Settings You may modify Account Settings by clicking the appropriate link under the Account Settings list To request information regarding a case you have not already associated to your account click the Request Case ee ene mane Access link below Update Account Information Designee Maintenance To see cases thst you have previously associated to your account click the Case Listing link below View Account Activity Change Password Request Case Access X J Case Listing Lass SSS SSS SSS SSS The Logoff link at the top right side of the page allows you to log out of the MSPRP system Rev 2012 1 July Page 50 MSPRP User Manual Chapter 7 Account Settings for Account Manager Chapter 7 Account Settings for Account Manager The Account Managers can access functions in the Account Settings box Note Access is limited by user role Account Designees are able to perform a few of these functions Account Managers e Update Personal Information Update Account Information Designee Maintenance Corporate and Representative accounts only View Account Activity Change Password Account Designees Corporate and Representative Account Types e Update Personal Information e View Account Activity e Change Password The user must login to the MSPRP portal using the user name and password assigned Update Personal Information As Account Manager your persona
85. ev 2012 1 July Page 83 MSPRP User Manual Chapter 7 Account Settings for Account Manager View Account Activity All activity performed for an Account ID can be reviewed The system provides an Account Activity history page that lists Activity Date Description recovery Case ID and User Typical activity recorded includes Initial Registration Account Setup Account Manager Registration Add Designee Delete Designee Update of Account Information MSPRP Requests Submitted Document Replaced 1 On the Welcome page click the View Account Activity link in the Account Settings box to view the account activity history Account Settings Update Personal Information Updste Account Information Designee Maintenance View Account Activity Change Password 2 The Account Activity page is displayed The activity for accounts associated with this Account ID is displayed Rev 2012 1 July Page 84 MSPRP User Manual Chapter 7 Account Settings for Account Manager Skip Navigation Contact Us Logoff Help about this page Account Activity Print tis page Below is the account activity for the Account ID 99999 Please report any discrepancies to the Coordinstion of Benefits Contractor COBC Selecting Cancel will return to the Home Page Account Activity Activity Date Activity Description ReMas Case ID User May 09 2012 Account Setup AAR ABABA lacaai Privacy Policy User A
86. ffix optional Command Buttons Previous Click to return to the Select Account Type page Continue Click to save changes and continue to the next page Click to cancel the registration process Information entered on the current page and Cancel any previous pages is NOT saved 2 The Account Representative AR Information page is displayed This page captures information related to the AR As the AR you must enter your company information on this page Fields marked with an asterisk are required Note An AR can only have one role the AR cannot function as an Account Manager or an Account Designee E mail addresses for each user role will be verified upon entry and any address matches between AM AD and AR roles will be denied except for Representative accounts where the AR can also be the AM Enter the required information in the provided fields Then click Continue Medicare Secondary Payer Recovery Portal About This Site MS Links Reference Materials Account Representative AR Information aene O armana AR First Name MI Last Name AR Title E Mail Address Re enter E Mail Address Phone gt ext Fax 2T tee d Privacy Policy User Agreement Account Representative AR Information Page AR First Name Enter your first name Rev 2012 1 July Page 17 MSPRP User Manual Chapter 3 New Registration MI Enter your middle initial optional
87. ge allows you to navigate through the portal and perform all the recovery actions necessary For example you can setup accounts create login IDs for designees assign managers add designees perform maintenance on cases so information is correct and supporting documentation is uploaded and request case information just to name a few The available links on this home page are e Update your Personal Information your name address E mail phone e Update Account Information organization name address E mail and phone This is an AM function only e Designee Maintenance Manage Account Designees This is an AM function for Corporate and Representative Accounts only View Account Activity Change your Password e Request Case Access This link will not be functional until the Profile Report is signed and received by EDI e Case Listing This link will not be functional until the Profile Report is signed and received by EDL Quick Help sections with the Help About This Page links are provided within the MSPRP system Reference Materials Quick Help Welcome SS Navigste to field descriptions Link opens The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and in a new window provide information to assist in resolving Medicare s recovery claim Xv J With the use of this portal you may submit a valid suthorization request an update conditional payment amount submit s
88. ger You will only go through this process once as you need only one Login ID no matter how many Account IDs you will ultimately work with To successfully register yourself as an Account Designee follow the steps outlined below Account Designee Registration and Activation 1 Click on the token URL provided in the invitation E mail sent by Medicare The E mail will come from cobva ghimedicare com You must allow E mail deliveries from this address See sample E mail below Rev 2012 1 July Page 88 MSPRP User Manual Chapter 8 Account Designee Designee Invitation DoNotReply cob cms hhs gov Sent Thu 5 10 2012 3 58 PM AAA AAA AAA AAA AAA AAA AAA AAA PLEASE DO NOT REPLY TO THIS EMAIL Dear Name You have been invited by First Last for Account ID 99999 to participate in the Medicare Secondary Payer Recovery Portal MSPRP web portal process Please follow this link to register https qua cob cms_hhs gov MSPRP designeeRegistration token pZDiwwMBtwwMbw If you have already registered please visit the Medicare Secondary Payer Recovery Portal Welcome Page at https qua cob cms_hhs gov MSPRP to login For any questions or problems please contact the person named in the paragraph above This electronic message transmission is intended only for the person or entity to which it is addressed and may contain information that is privileged confidential or otherwise protected from disclosure If you
89. gistered user Designee E mail Address Re enter Designee E mail Address foam gt Cancel aa Privacy Policy User Agreement 6 Enter and re enter the E mail address of the Account Designee you wish to invite Then click Continue Or click Cancel to return to the Designee Listing page without adding a Designee The system verifies the E mail address is not already in the database for an existing user An existing registered user can be an Account Designee for your Account ID as long as they are not already registered as an Account Representative for any other Account ID or as long as they are not the Account Manager for the same Account ID If the entered E mail address is found in the system the invited Account Designee is already a registered user and your Account Designee will receive a notification E mail from the MSPRP notifying them that they have been designated as an Account Designee for your account on the MSPRP Web site Once this is completed the Designee may log into the MSPRP and complete tasks related to this MSPRP account See sample E mail invitation below Note If the Account Designee is not a registered user go to Step 7 below Rev 2012 1 July Page 69 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Invitation DoNotReply cob cms hhs gov Sent Thu 5 10 2012 3 58 PM AAA AAA AAA AAA AAA AAA AAA AAA 4 PLEASE DO NOT REPLY TO THIS
90. greement 3 After reviewing account activity history click Cancel to return to the Welcome page You can print the history by clicking Print this page at the top right of the page Rev 2012 1 July Page 85 MSPRP User Manual Chapter 7 Account Settings for Account Manager Change Password The system requires you to change your Password every 60 days The following details the steps to successfully change your Password Note You will need to change your password when it expires or when you have forgotten your password and a temporary password was assigned Your Password can only be changed once every 24 hours 1 On the Home page click the Change Password link in the Account Settings box on the right side of the page Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password 2 The Change Password page is displayed Enter your Current Password and then enter a new Password Re enter the password in the second field while following the listed guidelines Click Continue The Change Password Confirmation page displays _ Change Password gt Print this page Quick Help Help About This Page Choose your password carefully Password must be changed every sixty 60 days Password must consist of st least eight 8 characters Password must contain st least one upper case letter one lower case letter one number and one special
91. h you to understand the error and determine the solution Contact the EDI Department by phone at 646 458 6740 or by E mail at COB VA GHIMedicare com EDI representatives are available to assist you Monday through Friday excluding Federal holidays from 9 00 a m to 5 00 p m Eastern Time Rev 2012 1 July Page 7 MSPRP User Manual Chapter 2 About The Welcome to the MSPRP Page Chapter 2 About the Welcome to the MSPRP Page The Welcome to the MSPRP page is the portal to the MSPRP for all Medicare MSPRP request functions Before the MSPRP request process can begin the following steps must be performed using this page For Corporate account types the organization must be registered and given an Account ID For Corporate account types the Account Representative must be named For Representative account types the Account Representative must register and receive an Account ID Note The Account Representative must be named e The designated Account Manager must perform the Account Setup step for the Account ID for both account types e The Account Manager must self register obtain a Login ID and create a Password Once the Account ID and all users are registered the Welcome to the MSPRP page is used to login to the MSPRP system to manage the case information and MSPRP Request processes The following sections provide information about the section on this page CMS Linke y iks Sign in to your account Welcome to th
92. he Designee will need to click on each token for each account in order to register The Account Manager can perform the following Designee Maintenance functions Add an Account Designee Delete an Account Designee Edit information for an unregistered Account Designee Regenerate an invitation E mail with a token link for an Account Designee s registration Add a Designee to an Account 1 Login to the MSPRP portal as either a Corporate or Representative Account Manager 2 On the Welcome page click the Designee Maintenance link in the Account Settings box Account Settings Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password CE 3 The Designee Listing page displays with all Designees and their associated statuses Pending Active Locked Expired Revoked listed Note If this is the first time you are accessing the link or you do not have any accounts no Designee names will be displayed Rev 2012 1 July Page 67 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Listing D gt enn Help About This Page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the D
93. he claims listed below for dispute associated to Case ID 20110 00000 00000 Cack Continue wil return you to the Case Information page Claims Disputed Claim Control 1D ICN ani Total Charges Reimbursed Amount Condibonal Payment sses 9999999 1 205 00 77 05 77 05 serere 9999999 2 165 00 86 09 56 09 You have successfully submutec the following documentation for Me case sted above testpari23 pat Cack Continue wili return you to the Case information page 7 Click Continue to return to the Case Information page You will be able to dispute another claim Rev 2012 1 July Page 113 MSPRP User Manual Chapter 9 Beneficiary Provide the Notice of Settlement Information This page allows you to enter Notice of Settlement information upload supporting documentation for a settlement or elect the Fixed Percentage option Completion of this page will result in the issuance of a demand bill Refer to Chapter 10 Request Case Access Provide the Notice of Settlement Information section The section in Chapter 10 provides the steps to complete this action Settlement Information gt Print this page This page allows you to enter Notice of Settlement information upload Notice of Settlement documentation or elect the Fixed Percentage Option Completion of this page will result in the issuance of a demandi bill Note if you believe any of the claims listing on the Claims Listing Page are unrelated to the case click
94. he following information is correct for the account which you are going to compelete the Account Setup process If the information is correct please click the Continue button to proceed Corporate Information Account Representative Information Employer Identification Number EIN First Name FIRST MI M Last Name LAST Corporation Name AAAAAAAAA Phone HHHHHHHHH ext Business Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAASA Zip Code B Previous T gt Privacy Policy User Agreement 2 The Account Manager Personal Information page displays Refer to the Account Manager AM Setup section below Rev 2012 1 July Page 32 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Account Setup Representative After all information has been verified by the system the Account Setup Representative Information page displays This page displays information entered during the initial registration process 1 Review the listed information and click Continue You can print this page by clicking the Print this page link If any of the listed information is incorrect contact an EDI representative to have it ar f Tale ae corrected a _ Account Setup Representative Information gt Print tis page Plesse verify the following individual is the Account Representative for the account which you sre going to co
95. his Beneficiary Medicare Number 888 Conditional Payment Letter Mail Date Beneficiary DOB 88 58 Current Conditional Payment Amount 0 00 Beneficiary Last Name AAAA Conditional Payment Amount was updated on Be RR eRe Authorization Level Demand Letter Mail Date Authorization Status Demand Amount 0 00 Please select an action from the following list if the option is disabled it may not be available for the case at this time View Request Authorizstions Proof of Representation or Consent to Release Request an update to the conditional payment amount What is this Request a copy of the conditional payment letter What is this View Dispute Claims Listing What is this Provide the Notice of Settlement Information conve Reel Privacy Policy User Agreement Field Description Case ID The beneficiary case ID is displayed Case Type The type of case is displayed The status of the case is displayed There are 7 different status types In Development Open Claim Retrieval Demand Bill Issued and Closed For more information refer to the section Help About This Page Case Information below Case Status Rev 2012 1 July Page 118 MSPRP User Manual Chapter 10 Request Case Access Rights and Responsibilities Letter Mail Date Beneficiary Medicare Number Beneficiary DOB Beneficiary Last Name The date the Rights and Responsibilities was sent out is di
96. ick Continue You will be returned to the Case Information page Rev 2012 1 July Page 129 MSPRP User Manual Chapter 10 Request Case Access View Dispute Claims Listing Selecting this option allows you to see the list of medical claims associated with the case The claims may also be found on a Payment Summary Form included with the Conditional Payment Letter This listing may differ from the last issued Payment Summary Form if there has been any recent case activity between the date of the Payment Summary Form and the current date 1 The Claims Listing page is displayed after you select the View Dispute Claims Listing option from the Case Information page The list of claims associated with the Case ID is displayed You can print out the list by clicking Print this page 2 You can dispute claims by selecting the check box next to the Claim Control ID number Then click Continue Claims Listing gt The following are the daims associated to Case ID 99999 99999 9999 Help About This Page These claims may also be found on a Payment Summary Form included with he Conditional Payment Letter This listing may difler fom Me last issued Payment Summary Form if there has Deen any recent case activity Detween the Gate of the Payment Summary Form and the current date Examples of recent case activity include ciaim disputes or requests for updated conditional payment amounts i you believe any of the daims listed on this screen
97. ill include a Profile Report noting all information previously recorded during registration and any additional information provided during the account setup It may take up to 10 business days to receive the Profile Report Contact the EDI Department if you do not receive a Profile Report after 10 business days The AR will have 60 business days to review sign and return the Profile Report to Medicare When returning the signed Profile Report via E mail MSPRP Profile Report should be indicated in the subject line You or the Account Representative will have 60 business days to review sign and return the Profile Report to Medicare When returning the signed Profile Report via email use MSPRP Profile Report in the subject line If a signed Profile Report is not received within that timeframe the account will be automatically deleted on the 60 business day If the account is deleted you must start the registration process from the beginning Below is a sample E mail From DoNotReply cob cms hhs gov mailto DoNotReply cob cms hhs gov Sent Tuesdav Mav 15 2012 4 01 PM To AAA A AAAA AAA AAA Subject Medicare Secondary Payer Recovery Portal MSPRP Profile Report Representative AAA A AAAASA Account Manager AAA A AAAAA The MSPRP Profile Report has been attached to this email The Profile Report contains information regarding the representative for the account and the associated account manager information A Profi
98. inks Provides links to other Medicare and Medicare Secondary Payer Web sites Provides detailed information on performing the following functions e Getting Started Requesting your Login ID Requesting your Password How To Changing your Password Resetting your PIN Changing your Account Manager Changing your Account Representative Inviting Account Designees Reference Materials Provides a link to the MSPRP User Manual this guide Contact Us Provides contact information for EDI including phone number Logoff Allows the user to end the portal session and exit the system About the Bulletin Board Bulletin board messages display on the Welcome to the MSPRP page These messages keep users informed of upcoming events maintenance or other system specific information About This Site MSPRP Messages This space is reserved for system messages Check this location for important information regarding system outages scheduled maintenance and special announcements Rev 2012 1 July Page 9 MSPRP User Manual Chapter 2 About The Welcome to the MSPRP Page About the New Registration Button This is the first step in creating a new account You must first register the company in the MSPRP system To do this the designated Account Representative AR must click on Step 1 New Registration to begin the registration process It is critical that you provide the Account Representative s information including E mail addr
99. ion An asterisk indicates a required field Help About This Page First Name MI Last Name E mail Address Phone a H ext Mailing Address Address Line 1 Address Line 2 City State Please Select Zip Code You must read the User Agreement provided in the s olling box To accept the agreement click the checkbox You must accept and agree to the terms of the User Agreement in order to continue through the registration process View and print the agreement below User Agreement THE FOLLOWING DESCRIBES THE TERMS AND CONDITIONS BY WHICH THE CENTERS FOR MEDICARE amp MEDICAID SERVICES CMS OFFERS YOU ACCESS TO THE MEDICARE SECONDARY PAYER RECOVERY PORTAL MPSRP SECURE WEB SITE You must read and accept the terms and conditions contained in this User Agreement everecely cot nit halaw and innarnnratar hv reference hafnra wm mow arcece the MOPRPE Please check the following box m accept the User Agreement and Privacy Policy above OE E MI Enter your middle initial optional Last Name Enter your last name E mail Address Enter your personal E mail address Phone Enter your personal phone number Ext Enter the extension for your phone number optional Address Line 1 Enter the first line of the company s mailing address Address Line 2 Enter the second line of the company s mailing address optional City Enter the city where the company is l
100. irements set forth to use this process and have read and understand all of the Centers for Medicare amp Medicaid Services information at http Awww cms gowMSPRGenInfo LOG OFF IMMEDIATELY if you do not agree to the conditions stated in this warning Accept Decline 1 A Privacy Act system of records is a group of any records about individuals and under the control of any Federal agency from which information is retrieved by the name or other personal identifier of the individual Privacy Policy User Agreement Rev 2012 1 July Page 13 MSPRP User Manual Chapter 3 New Registration 3 The Welcome to the MSPRP page displays Reference Materials Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims Forgot ID Getting Started If you sre a Medicare Beneficiary snd would like to use the MSPRP to request case information please login to your x SPRE 3 K Forgot Password MyMedicare account by visiting the MyMedicare gov website at https mymedicare gov Losid Clea For more information refer to How To Get Started under the How To menu option To begin the registration proce
101. iteris and click the search button ReMAS Case ID Selecting Cancel will return to the Home Page Cases ReMas Case ID Bene Last Name Bene HICN SSN Bene Date of Birth Case Access 99999999999999 AAAAAA 9999 99 99 9999 Manage Access Cancel EJ Privacy Policy User Agreement 4 This page displays all cases associated with your Login ID You can view the case detail information by clicking on the Manage Access link displayed This page also allows you to search for specific cases by providing search criteria You must enter information in at least one of the fields ReMas Case ID Beneficiary HICN or Beneficiary SSN Click the Search button to perform the case search Field Description ReMas Case ID Recovery case identification number Enter the case number to search for case details Enter the Medicare number for the beneficiary on the case as entered when the case Beneficiary HICN was created Enter the social security number for the beneficiary on the case as entered when Beneficiary SSN the case was created Command Buttons Cancel Click the Cancel button to return to the Welcome page 5 The Manage Case Access page is displayed Select the Grant Revoke Access check box for each Designee Select the checkbox next to the Designee s name to Grant access Then click Continue Rev 2012 1 July Page 147 MSPRP User Manual Chapter 11 Manage Case Access Note If you un chec
102. ith Note Your personal information must be entered at this point to register yourself as the Account Manager 1 The Account Manager Personal Information page is displayed after you have reviewed the Account Setup page The information you enter here is required for subsequent communications 2 For a Corporate account enter the required personal information and the case processing mailing address This is the address that will be used to send Medicare correspondence related to this Account ID Note If you are entering information for a Representative not Corporate account you will see the Same as Submitter button at the top of the page If you click this button the fields will automatically populate with personal information of the person who initially registered the account Do not click the button if you did not complete the initial registration step for this Representative account and have been assigned the AM duties by the AR Same as Submitter After entering the Account Manager information review the Data User Agreement and click I accept the User Agreement and Privacy Policy above Then click Continue The Account Manager Personal Information page is displayed Rev 2012 1 July Page 34 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Enter the required information in the fields provided Then click Continue About This Site CMS Links w Te Reference Materials Account Manager Personal Informat
103. its the disclosure of information maintained by the Centers for Medicare amp Medicaid Services CMS in a system of records to third parties unless the beneficiary provides a written request or explicit written consent authorization for a party to receive such information Where the beneficiary provides written consent proof of representation CMS will permit authorized parties to access requisite information Attestation of Information The information provided is complete truthful accurate and meets all requirements set forth to use this process and have read and understand all of the Centers for Medicare amp Medicaid Services information at http Awww cms gowMSPRGeniInfo LOG OFF IMMEDIATELY if you do not agree to the conditions stated in this warning Accept Decline 1 A Privacy Act system of records is a group of any records about individuals and under the control of any Federal agency from which information is retrieved by the name or other personal identifier of the individual Privacy Policy User Agreement 3 Review the DUA To proceed click the I Accept link at the bottom of the page You will be denied access to the MSPRP registration process if you click I Decline 4 The Designee Registration page displays Rev 2012 1 July Page 90 MSPRP User Manual Chapter 8 Account Designee H j Designee Registration Help About This Page The Account Manager listed below has invited you to be a
104. k indicates a required field Enter your Login ID er am gt Cancel EJ Privacy Policy User Agreement Rev 2012 1 July Page 47 MSPRP User Manual Chapter 5 Login to the MSPRP Site 3 The Forgot Login ID or Password page displays Answer the two security questions with information you provided during the registration process Correctly answer each of your pre selected security questions Then click Continue If the information you entered is correct your new temporary password will be sent via Email If you receive an error indicating that the answers are incorrect check your answers and enter the information again If you cannot remember the answers to your security questions contact an EDI J s representative 2 Forgot Login ID or Password Quick Help Help About This Page An asterisk indicates a required field Security Question 1 What is your favorite beversge Answer 1 Security Question 2 Who is your favorite entertainer Answer 2 Continue gt Cancel Privacy Policy User Agreement 4 The Forgot Password Confirmation page displays if your answers are correct indicating that the system has generated a temporary password and sent it to your registered E mail address If you do not receive an E mail within 24 hours contact an EDI representative Rev 2012 1 July Page 48 MSPRP User Manual Chapter 5 Login to the MSPRP Site 4 a
105. k the box the Designee s access will be Revoked Medicare Secondary Payer Recovery Portal Manage Case Access Case ID sssssssssssses3 Beneficiary Last Name AAAA You may select a designee by checking the checkbox next to their name To select all Designees click the Select All checkbox To remove all previously selected designees click on the Select All checkbox twice Designee associations for the case Designee Name Grant Revoke Access AAAA AAAAAA E Select All ute gt Cancel Privacy Policy User Agreement 6 The Case Access Confirmation page is displayed The list of Designees that have access to this case is displayed You can print this page using the Print this page link Click Continue 7 The Case List page is displayed again You can search for another case or click Cancel to exit This process has been completed Rev 2012 1 July Page 148 MSPRP User Manual Chapter 12 Signoff Chapter 12 Signoff 1 From any page in the MSPRP click the Logoff link at the top right side of the page Home About This Site CMS Links iow To Reference Materials Contact Us Logoff Sign off successful Help About This Page You have successfully signed off the Medicare Secondary Payer Recovery Portal system The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s re
106. l information is recorded during your initial registration process However this information can be updated and changed if necessary This page displays the personal information associated with your Login ID 1 Onthe Welcome page click the Update Personal Information link in the Account Settings box Account Settings Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password 2 This displays the Update Personal Information page Rev 2012 1 July Page 51 MSPRP User Manual Chapter 7 Account Settings for Account Manager An asterisk indicates a required field First Name Email Address j Re enter Email Address Update Personal Information Reference Materials a gt Print this page Help About This Page Last Name Mailing Address Address Line 1 Address Line 2 City State Zip Code Phone 3 Dei Privacy Policy User Agreement 3 Your current personal information is displayed Review the information and make any necessary changes You will need to type your email address in the Re enter Email Address field Then click Continue Field Description First Name Enter your first name MI Enter your middle initial optional Last Name Enter your last name E mail Address Re enter E mail Address Enter your personal E mail address
107. le No Fsult Case Status OPEN What is this Beneficiary Medicare Number 484 Conditional Payment Letter Mail Date Beneficiary DOB 55 Current Conditional Payment Amount 0 00 Beneficiary Last Name AAAA Conditional Payment Amount was updated on RJRR HRHE Authorization Level AAAA Demand Letter Mail Date Authorization Status AAAA Demand Amount 0 00 Please select an action from the following list if the option is disabled it may not be available for the case at this time View Request Authorizations Proof of Representation or Consent to Release Request an update to the conditional payment amount What is this Request a copy of the conditional payment letter What is this View Dispute Claims Listing What is this Provide the Notice of Settlement Information conve Ie Privacy Policy User Agreement 9 Select another option from the list or click Cancel to return to the Welcome Page Rev 2012 1 July Page 125 MSPRP User Manual Chapter 10 Request Case Access Request an Update to the Conditional Payment Amount Selecting this option allows you to request current information about conditional payment amount You must request that your account be updated to receive view the most current information for this claim This process will retrieve all additional medical claims and determine what should or should not be associated to the case When this process is complete the Conditional Payme
108. le Report is generated after the account setup has been completed successfully Please review the attached Profile Report carefully and ensure all information is accurate In order to access all of the functions within the MSPRP the report must be signed by the account manager and retumed to the COBC Please send signed reports to via Fax 646 458 6761 via Email COBVA GHIMedicare com via mail MEDICARE MSPRP Profile Report P O Box 660 New York NY 10274 0660 If the revort is incorrect please contact our Electronic Data Interchange EDI department at the number or Email Rev 2012 1 July Page 40 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Below is a sample Profile Report Medicare Secondary Payer Recovery Portal Profile Report Account ID 99999 Account Type Representative Date Month Date Year EDI Contact Information Email AAAA AAA AAA Phone HEHH HHH Representative Name AAAA Phone AHEHE HHHH Address AAAA AAAA AA BH Email AAAA AAA AAA Account Manager Name AAAA Phone saps see Address AAAA AAAA AA AHHH Email AAAA AAA AAA Account ID 31194 Account Type Representative Date Month Date Year EDI Contact Information Email AAAA AAA AAA Phone H HHHE At the bottom of the report the AR will be required to sign and date the report For Representative accounts if the AM is the same individual as the AR then the AM can sign the report SAFEGUA
109. luding the Data Use Agreement and returning it to Medicare The Account Manager can change the Account Representative by using the Update Corporate Information process as described in Chapter 7 Account Manager AM Role Each MSPRP Account must have an assigned Account Manager AM The Account Manager is established during the Account Setup process Step 2 in MSPRP Each MSPRP account can have only one Account Manager This is the individual who controls the administration of an organization s account and manages cases which includes managing case information access The Account Manager can only be associated with one MSPRP account The Account Manager is a registered user of the system Account Managers have unlimited access to MSPRP functionality and cases e The Beneficiary is by default the Account Manager for their recovery Case IDs e For Corporate and Representative account types the Account Manager is assigned during the Account Setup process For Representative accounts the Account Representative may be the Account Manager but they have the option to assign the Account Manager role to another person The Account Manager e For Representative account types Reviews signs and returns the Profile Report upon its receipt in order to be granted full access to all MSPRP functionality e For Corporate account types the Account Manager will only be granted access after the Profile Report is signed and returned by the Ac
110. mpelete the Account Setup process If the informastion is correct please click the Continue button to proceed Quick Help Help About This Page Representative Information First Name FIRST MI M Last Name LAST Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code 4 Phone HHRHH ext H Privacy Policy User Agreement 2 The Account Manager Personal Information page displays Refer to the Account Manager AM Setup section below Rev 2012 1 July Page 33 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Account Manager AM Setup The Account Manager AM controls the administration of a specific MSPRP account The AM has the following responsibilities e Reviews signs and returns the Profile Report upon its receipt in order to be granted full access to all MSPRP functionality For Corporate accounts the Account Representative signs the Profile Report Manages the MSPRP account s information and updates general account information Invites other users to function as Account Designees AD Grants adds Account Designees to cases Revokes removes Account Designee s access to cases and or an entire MSPRP account Can send requests for the MSPRP account they are associated with Can view and update all cases for the MSPRP account they are associated with e Can add documentation in a specific case for the MSPRP account they are associated w
111. n Employer Identification Number EIN and will be regularly submitting MSPRP requests Representative A representative account type indicates that the entity does not have an Employer Identification Number EIN but will be regularly submitting MSPRP requests eae gt Cancel EJ Privacy Policy User Agreement 6 Click Continue The next page that displays depends on the account type selected Follow the steps for Corporate Account Type or Representative Account Type in the sections below Rev 2012 1 July Page 15 MSPRP User Manual Chapter 3 New Registration Corporate Account Type For Corporate account type the Corporate Information page displays Enter the corporation s EIN TIN and mailing address on this page This address will be used when sending the post registration letter which will include your Account ID and Personal Identification Number PIN which will be used by the Account Manager during Account Setup This information must be sent to the AR for authorization Any correspondence from Medicare regarding this Account ID will also be sent to this address unless you instruct your Account Manager AM to enter a different address during Account Setup The Profile Report which is generated after the Account Setup process will be sent to the Account Representative s E mail address the AM will be copied Fields marked with an asterisk are required 1 Enter the requested information in
112. n asterisk indicates a required field Select the authorization type Consent to Release What is Consent to Release Please click the Help about this page link to view the descriptions of these suthorizstion types Please select from one of the following which best describes the representation type Select Start Date of ye MIDDICCYY Authorization End Date of Authorization i MMM DDICCYY Optional Supporting Documentation is Required Please refer to Help About This Page to identify what documents should be submitted Upload Documentation To upload supporting documenation please click here Below is a list of documents to be submitted for the case If you d like to delete a document from the list click the Delete link to the right of the document name Selecting Continue will submit the files to CMS Selecting Cancel will return you to the Case Information page the files will not be submitted to CMS Continue gt Cancel Privacy Policy User Agreement Rev 2012 1 July Page 121 MSPRP User Manual Chapter 10 Request Case Access 6 From the Authorization Documentation Upload click Browse to locate the document you want to upload Note The document must be in Adobe Acrobat pdf format to upload to the system and less than or equal to 40 MB in size Then click Continue The uploaded document will be displayed on the page See the sample below Medicare Secondary Payer Recovery Port
113. name or mailing address You can also update or replace the existing Account Representative s name or update the Account Representative s personal information Update Corporate Information 1 Onthe Welcome page click the Update Account Information link in the Account Settings box Account Managers only Account Settings Updste Personal Information Updste Account Information Designee Maintenance View Account Activity Change Password 2 The Update Corporate Information page is displayed You can update your Corporate information or the Account Representative s contact information from this page Rev 2012 1 July Page 55 MSPRP User Manual Chapter 7 Account Settings for Account Manager 3 To update the Corporate information click Edit next to the Corporate Information heading The Corporate Information page is displayed Proceed to Step 4 below To update the Account Representative s information click Edit next to the Account Representative AR Information heading Proceed to Step 7 below Update Corporate Information io Help About This Page You may edit the Corporate Account information or Account Representative information by clicking on the Edit button of that section You may not change the account type Click the Continue button to submit the changes Click the Cancel button to return to the Home Page sll changes will be lost Account Type Corporste Corporate
114. nd associated with this case This page will allow the submission of new authorizations and upload supporting documentation This option is not for the Beneficiary or Debtor 1 Click View Request Authorizations Proof of Representation or Consent to Release The Authorization Documentation page is displayed 2 Select the authorization type Consent to Release or Proof of Representation Then click the drop down arrow to select the type of representation that is authorized to have access to the case The following options are available Attorney Guardian Conservator Power of Attorney Individual Other Third Party Administrator 4 Enter the Start Date of Authorization Note The authorization date must be on or before the current date 5 Enter End Date of Authorization This is an optional field and does not need to be populated Add any additional supporting documentation To attach supporting documentation to this case click the Upload Documentation link The Authorization Documentation Upload page is displayed Rev 2012 1 July Page 120 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal Authorization Documentation This page displays a list of authorizations currently on file that sre associated with the case This page will also allow the submission of new authorizations Authorizations Authorization Type Status What is this Start Date End Date Submit New Authorization A
115. neficiary s last name Beneficiary s Date of Birth Enter the beneficiary s date of birth Command Buttons Continue Click to save changes and continue to the next page Cancel Click to exit this page and return to the Welcome page without making any requests The Case Information page is displayed Rev 2012 1 July Page 117 MSPRP User Manual Chapter 10 Request Case Access Case Information This page provides details about the case such as case ID type status beneficiary information letter mail date current conditional payment amount and demand letter date This page allows you to request information add to the list of authorized people who can view or request information about the case Proof of Representation POR or Consent to Release COR request an update on the conditional payment amount request another copy of the conditional payment letter that you received before view and dispute claims and view and update settlement information For a description of the case actions that can be performed using the Case Information page see the tables below Or refer to the Help About This Page Case Information section below 6 Select the necessary option from the list to view or request case information Case Information Help About This Page Case ID ERRF sates EHHH Rights and Responsibilities Letter Mail Date Case Type Automobile No Fsult Case Status OPEN What is t
116. nfirmation Page is displayed You can print a copy of the confirmation page by clicking the Print this page link at the top right of the screen Click Continue to return to the Case Information page Rev 2012 1 July Page 126 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal s Logoff Help About This Page Conditional Payment Request Confirmation Page i gt Case ID sess sems seems Beneficiary HICN sexe Beneficiary Last Name AAA You have successfully requested an update to the conditions payment amount This request could take 3 to 5 days to complete Plesse login to the MSPRP Web site to verify that the conditions payment amount has been updsted No letter will be mailed Click Continue to return to the Case Informstion page Privacy Policy User Agreement Rev 2012 1 July Page 127 MSPRP User Manual Chapter 10 Request Case Access Request a Copy of the Conditional Payment Letter Selecting this option allows you to submit a request for a copy of the Conditional Payment Letter with the current conditional payment amount as displayed on the case information screen If you have recently requested an update to the conditional payment amount or recently disputed claims then you should wait until the current conditional payment amount is updated before requesting a copy of the conditional payment letter Please Note This is NOT a r
117. nning Refer to Chapter 4 for more information on completing the account setup Below is a sample letter with the PIN Rev 2012 1 July Page 25 MSPRP User Manual Chapter 3 New Registration CATS CENTERS for MEDICARE amp MEDICAID SERVICES sFIRST CLASS MAIL R 5 F 4 MMIDDIYYYY Name Address Line 1 Town State Zip Attn Name Medicare Secondary Payer Recovery Portal Registration Notification Your organization has been successfully verified and registered for the Medicare Secondary Payer Recovery Portal Through the Medicare Secondary Payer Recovery Portal MSPRP you o o may view current authorizations on file for a case submit requests to add authorized authorizations to case and with the confirmed proper authorization request an updated conditional payment amount request gencration of a conditional payment letter view and dispute claims attached to a o case and submit notice of settlement Please refer to the www msprc info Web site for more s information To begin using the MSPRP you must complete the registration setup process by creating an S account Please review the following user roles and required information carefully before attempting to complete the account setup MSPRP User Roles E Account Manager Each MSPRP account must have an Account Manager assigned The Account Manager must be selected and approved by the Authori
118. nt Amount and the Conditional Payment Calculation Date will be updated on the case information screen This request can take 3 5 business days You will need to login to MSPRP again and view your account to see if the information has been updated No E mail or letter will be sent 1 From the Case Information page click Request an update to the conditional payment amount Then click Continue Skip Navigatio Help About This Page Case Information Case ID EREE EEEE RHHE Rights and Responsibilities Letter Mail Date 5 8 Case Type Automobile No Fault Case Status OPEN What is this Beneficiary Medicare Number Conditional Payment Letter Mail Date Beneficiary DOB Current Conditional Payment Amount 0 00 Beneficiary Last Name AAAA Conditional Payment Amount was updated on HEJRR HEHH Authorization Level AAAA Demand Letter Mail Date Authorization Status AAAA Demand Amount 0 00 Please select an action from the following list if the option is disabled it may not be available for the case at this time View Request Authorizations Proof of Representation or Consent to Relesse Request an update to the conditional payment amount What is this Request a copy of the conditional payment letter What is this View Dispute Claims Listing What is this Provide the Notice of Settlement Information P cone oa Privacy Policy User Agreement 2 The Conditional Payment Request Co
119. nt Login fields Note Account Managers and Account Designees cannot submit MSPRP requests until the EDI Department receives a valid signed copy of the Profile Report however the Account Manages can perform Account Designee maintenance Refer to Chapter 9 Account Designee for information on the Account Designee self registration process Refer to Chapter 5 Login to the MSPRP Site for more information about the login process including information on the Forgot Login ID and Forgot Password links on the Welcome to the MSPRP page Rev 2012 1 July Page 10 MSPRP User Manual Chapter 2 About The Welcome to the MSPRP Page Sign in to your account Forgot ID Password Forgot Password Login Clear Rev 2012 1 July Page 11 MSPRP User Manual Chapter 3 New Registration Chapter 3 New Registration Step 1 The new registration process is only for Account Representatives This is the first step in the process for registering a new company For Representative accounts the two roles Account Representative and Account Manager may be performed by the same person For Corporate accounts the two roles Account Representative and Account Manager must be performed by different people Note Once you have started registration you must complete the process If you click Cancel or close the application at any point before registration is complete your changes will NOT be saved and all entered data will be lost Consid
120. nt in accordance with the instructions noted within the E mail You will not be able to request case access within the portal until a signed Profile Report has been received and processed by the EDI Help Desk Department Prior to the submission of a signed Profile Report you will have access to limited functionality within the portal For example you may return to the Medicare Secondary Payer Recovery Portal Web site Welcome page login using the Login ID and Password you just ceated and invite other users to become Account Designees associated with your Account ID This is done by using the Designee Maintenance link on the MSPRP Home page after you have logged into the Medicare Secondary Payer Recovery Portal Web site You can visit the Medicare Secondary Payer Recovery Portal Welcome Page st https qus cob cms hhs gov MSPRP or click the Exit button below Privacy Policy User Agreement 8 Click Exit and return to the Welcome to the MSPRP page Next Steps You have successfully setup the account and registered yourself as the Account Manager As the AM you control the administration of the MSPRP account A Profile Report from Medicare via E mail will be sent to the AR listed on the account which must be reviewed for accuracy then signed and returned to Medicare You will have limited functionality within the portal until the Profile Report is returned You cannot submit view or create cases until the signed Profile Report is received
121. nted by clicking the Print this page link in the upper right of the page Medicare Secondary Payer Recovery Portal A Login Warning Print this page UNAUTHORIZED ACCESS TO THIS COMPUTER SYSTEM IS PROHIBITED BY LAW This web site is maintained by the U S Government and is protected by federal law Use of this computer system without authority or in excess of granted authority such as access through use of anothers Login ID and or password may be in violation of federal law including the False Claims Act the Computer Fraud and Abuse Act and other relevant provisions of federal civil and criminal law Violators may be subject to administrative disciplinary action and civil and criminal penalties including civil monetary penalties For site security purposes we employ software programs to monitor and identify unauthorized access unauthorized attempts to upload or change information or attempts to otherwise cause damage In the event of authorized law enforcement investigations and pursuant to any required legal process information from these sources may be used to help identify an unauthorized individual who has accessed uploaded changed or attempted to access upload or change information through this site and may be used for administrative criminal or other adverse action So that the CMS Web site remains accurate and available to you and all other visitors we monitor network traffic to identify unauthorized attempts to
122. o access the MSPRP in two different ways e If the Beneficiary clicks the Go to MSPRP button on the Medicare page the MSPRP Welcome page is displayed Proceed to the Login through MyMedicare Go To MSPRP Button section below e Ifthe Beneficiary clicks on a Case ID in the Payment Details box on the MyMedicare page the MSPRP Case Information page will is displayed with the specific case details Proceed to the Login through MyMedicare Case ID section below Rev 2012 1 July Page 104 MSPRP User Manual Chapter 9 Beneficiary Login through MyMedicare Go To MSPRP Button The Welcome page is displayed The Beneficiary will be able to access the following links Request Case Access Case Listing and Help About This Page The Beneficiary can access case information using either of the two links Request Case Access or Case Listing e To search for a case using the recovery Case ID number click Request Case Access The New Case Request page is displayed Proceed to Chapter 10 Request Case Access to continue with the New Case Request section e To view the list of recovery Case IDs available to you click Case Listing The Case Listing page is displayed Here you can see the list of recovery Case IDs available to you You can search for a case ID by entering information into one or more fields Proceed to Chapter 10 Request Case Access to continue with the Case Listing section Medicare Secondary Payer Recover
123. ocated State Select the state where the company is located from the drop down list Note To quickly select a state type the first letter to scroll to the desired state Rev 2012 1 July Page 35 MSPRP User Manual Chapter 4 Account ID amp Account Manager Setup Zip Code Enter the company s zip code required plus 4 digit zip code suffix optional Command Buttons Previous Click to return to the Account Setup Intro page Continue Click to save changes and continue to the next page 3 The Account Manager Login Information page displays Here you can set up a Login ID and Password Additionally 2 security questions must be selected Medicare Secondary Payer Recovery Portal About This Site Reference Materials Account Manager Login Information The security information requested on this page will allow the system to authenticate your identity each time you log on This will ensure only you sre provided the access and updating priviledges restricted to the Account Manager Choose your Login ID snd password carefully Login IDs must be 7 characters Login IDs must be unique within the system Login IDs must be in the format of AASSSAA first two alphabetic next three numeric last two alphabetic Password must be changed every sixty 60 days Password must consist of st least eight 8 characters Password must contain st least one upper case letter one lower case letter one
124. of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individusl s name Use the Add a Designee function to include an individual ss a designee Individuals added as designees will receive an e mail notifying them that they have been invited to be s designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status x AAA AAAAA AAA AAA AAA AAA AAA AAA AAAA 3 The Update Designee Information page displays with the Designee s personal information open for editing Rev 2012 1 July Page 80 MSPRP User Manual Chapter 7 Account Settings for Account Manager e You must enter the Designee s E mail address in the Re enter Designee E mail Address field e You must enter the Designee s passphrase in the Re enter Passphrase field e Select the Regenerate token Check this box if another invitation e mail must be sent to the Designee checkbox Then click Continue Update Designee Information gt Tar Help About This Page Plesse click the Continue button to update the information of a potential designee To cancel and return to the Designee Listing page click the Cancel button An asterisk indicates a required field Designee First Name Designee Last Name Designee E mail Address Re enter Designee E mail Address Pas
125. of daims associated to Case ID 99999 99999 99999 ou have selected for dispute please review for accuracy To revise your selection click the Previous bution Help About This Page Claims Disputed Claim Control ID ICN padi Total Charges Reimbursed Amount Condibonal Payment seeeee9999999 1 205 00 77 05 77 05 seeereng999999 2 165 00 56 09 56 09 Supporting Information amp Documentation Please provide a brief description of the injury and explanation for any Claims you disputed as unrelated to he case Hyou have more than one explanation please provide the date range for each explanation Example Claims with ihe dates betwoon January 1 2010 and September 13 2010 were for back surgery dut this case is for a sprained knee Enter text here Please note Supporting information Notes cannot exceed 500 characters For disputes that require additional information please upload supporting documentation Examples of when supporting Gocumentation should Oe uploaded include providing clarification of incident related injuries proving a pre existing Condition or establishing incident end date of treatment Upload Documentation To upload supporting documenation please click here Below ts a list of documents to be submitted for the case If you d like to delete a document fom ihe list click he Delete link to the night of he document name AMAA PDF Delete Select Continue to confirm submission of the dispute and to submit any provide
126. of the address The corporation s business mailing address is displayed Make any necessary changes to the second line of the address optional The city where the corporation is located is displayed Make any necessary changes to Command Buttons City the name of the city The state where the corporation is located is displayed Make any necessary changes State to the state by using the drop down list Note To quickly select a state type the first letter to scroll to the desired state Zip Code The corporation s zip code is displayed Make any necessary changes to the zip code and 4 digit zip code suffix optional Rev 2012 1 July Page 57 MSPRP User Manual Chapter 7 Account Settings for Account Manager Previous Click to return to the prior page Continue Click to save changes and continue to the next page Cancel Click to return to the Welcome page Any information you entered will not be saved 5 The Update Corporate Information page is displayed again This page will display the updated information Account Type Corporate Corporate Information Corporate Name AAAAAAAAAA Business Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code Hs Update Corporate Information aaa Help About This Page You may edit the Corporate Account information or Account Representative information by clicking on the
127. ombination or to unlock the PIN Rev 2012 1 July Page 150 MSPRP User Manual Chapter 13 Troubleshooting Account ID Already Registered During Account Setup an error message will display on the Account Setup page if you enter an Account ID and PIN that has already successfully completed the setup process The message will indicate that the account is already setup Because the account is already setup you cannot self register as the Account Manager for the Account ID or repeat the Account Setup process There can be only one Account Manager for each Account ID If you had previously completed Account Setup for the Account ID and registered as the Account Manager go back to the Welcome page and enter your Login ID and Password to sign in to the MSPRP site If you are not the Account Manager contact the existing Account Manager to add you as an Account Designee if you need access to the system Account Manager and Account Representative E mail Addresses Match An error message will display if during Account Setup and Account Manager self registration it is found that your E mail address as the AM matches the E mail address of any Account Representative recorded in the system Account Representatives can NOT be users of the MSPRP site for any Account ID Click Continue on the error message to be returned to the Welcome page If the wrong individual was named as the Account Representative in the New Registration step contact an EDI re
128. on 0 0 ee eeseeseeseesseecesecesecesecesecsseeeeeseeeseeeeeaeeeaeeeaeeeaaeenaes 151 Incorrect PASS PHT ASE renren orae N a E aa ssadaugdset sob aes r EEE 151 Unsuccessful Losin jissssiss dacsieteis seat cisceiess sobs utes a aa A ae e aA e E A AEE A ER R 152 Inyalid Login ID asec niie eose uione orei ni Ee ETAT AEN eE E assis a AiE EEA A EEE EE auii 152 Inac ve Lorin MD sesrieeseiberuni asetin eei enaere E E SEESE E DEEE EAE a AE EE EAEE RENAS 152 Revoked Login IDo tcscccstitseeva ceueedl aeiciaatenpesciinceeaatebeoens oabfeppedanonaseaiogerassbiyendi oohsavendusnpsseetonrvaessloosvieetle 152 Invalid PassWord oieracea ai ee a iE A E EEEE aE E EEEE EE 152 Expired Pass Wr iseseisana nE E E E E E R E 152 Deleted Acco fites secete drinne eea ase A A an et a EAE ase OTEA E aE E iE EEE iS 152 Case Reguest ErrOTS eenean onneen daisies EA E E E iE AA ASEA ae 152 Concurrent SESSIONS epis iinr idinon NENE ENAN E ESENKENT ANERE EA OE EERSTE NERE EREN EKENS 153 Rev 2012 1 July Page 3 MSPRP User Manual Chapter 1 Introduction Chapter 1 Introduction Overview The Medicare Secondary Payer Recovery Portal MSPRP is a secure Web based application that provides attorneys representatives beneficiaries insurers claimants and third party payers TPAs the ability to access and update certain Medicare Secondary Payer MSP case specific information online via the MSP recovery web portal The MSPRP allows users to e Submit Proof of Representati
129. on or Consent to Release documentation Request an update to a conditional payment amount Request a copy of the conditional payment letter View Dispute claims included in a conditional payment letter Submit the Notice of Settlement information This user guide was written to help the user understand the MSPRP how to complete the corporation organization s registration and access available case function processes The information in this guide should be used in unison with the reference material available on the portal including the How To and Help About This Page documentation All instructions are available on the MSPRP Web portal https www cob cms hhs gov MSPRP Account Types Before beginning the registration process you must determine your account type There are two types of MSPRP accounts Corporate and Representative Account types are mutually exclusive and require registration on the Web portal and you can only select one account type during registration e Corporate account type indicates that the entity has an Employer Identification Number EIN and will be regularly submitting MSPRP requests e Representative account type indicates that the entity does not have an EIN but will be regularly submitting MSPRP requests Beneficiaries do not need to register to use the MSPRP Beneficiaries must log in to their MyMedicare account via the MyMedicare gov Web site at https mymedicare gov using their established Login I
130. one number and one special character Password must contain a minimum of four 4 changed characters from the previous password Password cannot be changed more than once per day Password must be different from the previous 6 passwords Password cannot contain a reserved word See Help About This Page for a complete list An asterisk indicates a required field Login ID Password Re enter Password The Security Questions allow you to regsin account access if you forget your password Please note the answers you provide to these questions should be actual answers and not hints for your password Choose Security Questions and Provide Answers Security Question 1 What is your favorite beverage Answer 1 Security Question 2 Who is your favorite entertainer z Answer 2 e Field Description Login ID Enter a new Login ID that will be assigned to the Designee Password Enter a new password that will be assigned to the Designee Re enter Password Enter the new password a second time for verification purposes Click the drop down arrow to view the list of security question Select one question to Security Question 1 Aasha Answer 1 Enter your answer to the security question Make sure to remember this answer Click the drop down arrow to view the list of security question Select one question to Security Question 2 answer Answer 2 Enter your answer to the security question
131. orization request has been reviewed and approved Rev 2012 1 July Page 139 MSPRP User Manual Chapter 10 Request Case Access Unverified Your authorization request has been submitted and is currently under review Your authorization request has been reviewed and not approved due to one of the following reasons e Missing or Insufficient Supporting Documentation required fields information is missing from the authorization document s uploaded e Missing Required Signature s one or more signatures may be missing from the authorization document i e the beneficiary or attorney s signature Invalid e Authorization Date s conflict with Supporting Documentation the date s submitted on the authorization page differ from the dates listed on the supporting documents uploaded e Authorization Invalid for multiple other reason s the authorization document is missing more than one required item If the authorization status is Invalid please remediate the error and resubmit your authorization request Available Case Actions and Functions The page will display the following list of case actions Note If you have already been accepted into the Fixed Percentage or Self Calculated CP amount options you will only be able to view the case information and no further actions can be taken on the MSPRP e Request to file an Authorization o This option will allow the user to submit the necessary paperwork to
132. ou must request that your account be updated to receive view the most current information for this claim Refer to Chapter 10 Request Case Access Request an update to the conditional payment amount section The section in Chapter 10 provides the steps to complete this action ome Abo ite c Links How To s Logo Case Information faina Help About This Page Case ID PSPF sane AHEHE Rights and Responsibilities Letter Mail Date Case Type Automobile No Fault Case Status OPEN What is this Beneficiary Medicare Number 8 Conditional Payment Letter Mail Date Beneficiary DOB H H Current Conditional Payment Amount 0 00 Beneficiary Last Name AAAA Conditional Payment Amount was updated on Authorization Level AAAA Demand Letter Mail Date Authorization Status AAAA Demand Amount 0 00 Please select an action from the following list if the option is disabled it may not be available for the case at this time View Request Authorizations Proof of Representation or Consent to Release Request an update to the conditional payment amount What is this Request a copy of the conditions payment letter What is this View Dispute Claims Listing What is this Provide the Notice of Settlement Information EI ea Request a Copy of the Conditional Payment Letter Selecting this option allows you to submit a request for a copy of the Conditional Payment Letter with the current conditional payment
133. ou d like to delete a document from the list click the Delete link to the right of the document name AAAA PDF Delete Selecting Continue will submit the files to CMS Selecting Cancel will return you to the Case Information page the files will not be submitted to CMS Privacy Policy User Agreement 7 Click Continue at the bottom of the Authorization Documentation page The Authorization Documentation Confirmation page is displayed Rev 2012 1 July Page 123 MSPRP User Manual Chapter 10 Request Case Access Authorization Documentation Confirmation Case ID sess sem sees Beneficiary HICN sss Beneficiary Last Name AAAA You have successfully submitted the Authorization documentation for the case listed above If you have additional documents to upload please click the Previous button to return to the Authorization Uplosd page Click Continue to return to the Case Information page Click the Cancel button to return to the Home Page ntinue gt Privacy Policy User Agreement 8 Click Continue You are returned to the Case Information page You can select another option from this page Rev 2012 1 July Page 124 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal Quick Help Help About This Page Case Information Case ID PERHE PHHH HEHHE Rights and Responsibilities Letter Mail Date 5 Case Type Automobi
134. ou to tie Case information page all changes will be lost and the documents will not be submitted to the MSPRC G3 Previous Contnue ooa Rev 2012 1 July Page 111 MSPRP User Manual Chapter 9 Beneficiary 4 If you clicked Upload Documentation the Dispute Claims Documentation Upload page is displayed 5 Click Browse to locate the document you want to upload Note The document must be in Adobe Acrobat pdf format Then click Continue The Claims Dispute Verification page is displayed again Medicare Secondary Payer Recovery Portal Dispute Claims Documentation Upload Help about tvs page Please click browse to find the document The document must de in POF format and the site limitis 40 MB megabyte per document for attachments Selectng Continue will upload the documents Selecting Cancel will return you to the View Dispute Claims Listing page and documents will not be uplosded E oo a Rev 2012 1 July Page 112 MSPRP User Manual Chapter 9 Beneficiary 6 The Claims Dispute Verification page is displayed and the document you uploaded is listed Note To delete uploaded documents click on the x next to the document name The document will be removed from the supporting documentation list Click Continue to confirm submission The Claims Dispute Confirmation page is displayed again Claims Dispute Confirmation eae Help Adout This Page You have successfully submited t
135. our dispute selections will be lost Click Cancel will retum you to the Home Page Note If the checkbox next to the claim number is disabled the claim may not be disputed Claims 5 Claim Control Line Processing Provider Diagnosis Total F Dispute TOS ID ICN Number Contractor Name Codes From Date To Date Charges AAA r 71 9999999999 1 000000591 AAAA 99999 10 16 2002 10 16 2002 70 00 AAA m 71 9999999999 1 000000591 AAAA 99999 10 16 2002 10 16 2002 95 00 99999 O 71 9999999999 1 000000591 AAAA 99999 10 28 2002 10 28 2002 35 00 Rev 2012 1 July Page 109 MSPRP User Manual Chapter 9 Beneficiary Field Dispute TOS Description Select the checkbox next to the Claim Control ID number that you want to dispute Type of Service that was entered on the claim when submitted Inpatient Outpatient etc Claim Control ID ICN Identification number associated with the submitted claim Line Number For Part A Institutional claims this number will always be 0 For Part B this number indicates one or more services that were billed on a single claim per Date of Service Processing Contractor Provider Name Identification Number of the Medicare claims contractor who processed the claim for payment Name of the Institutional or Individual Provider that submitted the claim for the service Diagnosis Codes From Date ICD9 10 Diagnosis codes associated with the claim th
136. p an E mail notification will be sent to you including a Profile Report denoting all information previously recorded during registration and any additional information provided during the account setup You will have 60 business days to review sign and return the Profile Report to the EDI Department When returning the signed Profile Report via email use MSPRP Profile Report in the subject line If a signed Profile Report is not received within that timeframe the account will be automatically deleted on the 60 business day If the account is deleted you must start the registration process from the beginning Refer to Chapter 4 Account Setup for more information on completing the account setup Rev 2012 1 July Page 20 MSPRP User Manual Chapter 3 New Registration Representative Account Type 1 For Representative account types the Representative Information page displays The information on this page is for the representative that will be sending MSPRP requests under this MSPRP Account ID Enter your personal information on this page The address you enter on this page will be used for any correspondence from the EDI Department regarding this Account ID Fields marked with an asterisk are required Enter the required information in the provided fields Then click Continue CMS Links ow To Reference Materials Representative Information An asterisk indicates a required field Help About This Page
137. page for your records Account Type Corporste Corporate Information Employer Identification Number EIN 33443334 Corporate Name AAAAAAAAASA Business Mailing Address Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code 534 T C Medicare Secondary Payer Recovery Portal Reference Materials gt Print nis page Help about this page Ean Account Representative AR Information z First Name FIRST MI M Last Name LAST Title AAAAA E Mail Address AAAAAAAAAA Phone e ext Fax eee Privacy Policy User Agreement 4 Verify that all information is correct To make any corrections click Edit next to the proper section to return to that page Once all corrections have been made click Continue at the bottom of that page Rev 2012 1 July Page 18 MSPRP User Manual Chapter 3 New Registration If you click Edit you will need to enter your E mail address in the Re enter E mail address field in the Account Representative AR Information page to continue After you have returned to the Registration Summary page click Continue Click Previous to return to the Account Representative AR Information page If you click Cancel you will exit the registration process All information entered during the registration process will be deleted 5 The Thank You page is displayed Important Your assigned Account ID is provided here Mak
138. presentative to make the necessary correction Unsuccessful Account Designee Invitation Account Designee E mail Address Matches Account Representative or Account Manager E mail Address An error message will display if while an Account Manager is adding an Account Designee to an Account ID it is found that the Designee s E mail address matches the E mail address of any Account Representative or Account Manager recorded in the system Account Representatives can NOT be users of the MSPRP site for any Account ID and Account Managers cannot also be Designees Click Continue on the error message to be returned to the Welcome page Account Designee E mail Address Matches Account Designee Already Associated with the Account An error message will display if while an Account Manager is adding an Account Designee to an Account ID it is found that the Designee s E mail address matches the E mail address of an Account Designee already assigned to the same Account ID Return to the Designee Listing page to manage the AD s case access Unsuccessful Account Designee Registration Incorrect Passphrase The Passphrase must be provided to you the AD by the Account Manager outside the system It will not be included in the invitation E mail The Account Manager s name is contained in the invitation E mail and can also be found on the registration page where the error is received Contact your Account Manager to obtain the Passphrase If
139. presentstive will be instructed to have the sppropriste Account Manager return to the Medicare Secondary Payer Recovery Portal Web site to complete the account setup The Account Msnager will need to enter the Account ID and PIN on the Account Setup page to begin setup Privacy Policy User Agreement 6 Click Exit to return to the Welcome to the MSPRP page Next Steps Within two weeks a letter will be mailed to you that contains the Account ID and PIN along with instructions for setting up the account to be completed by the AM If a letter is not received within 10 business days contact the EDI Help Desk Once the AM has completed the account setup an E mail notification will be sent to you with a copy to the AM as applicable for Representative accounts and will include a Profile Report denoting all information previously recorded during registration and any additional information provided during the account setup It may take up to 10 business days to receive the Profile Report You will have 60 business days to review sign and return the Profile Report to the EDI representative who is listed on the report When returning the signed Profile Report via E mail use MSPRP Profile Report in the subject line If a signed Profile Report is not received within that timeframe the account will be automatically deleted on the 60 business day If the account is deleted you must start the registration process from the begi
140. process Login Clea click the New Registration button STEP 1 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement 2 Enter your Login ID in the User Name field and your Password in the Password field Then click Login 3 The Welcome page displays This page functions as the main processing page to initiate any MSPRP functions Rev 2012 1 July Page 115 MSPRP User Manual Chapter 10 Request Case Access 4 Click Request Case Access The New Case Request page is displayed Welcome The Medicare Secondary Payer Recovery Portal provides s quick and efficient way to request case information snd provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an updste conditions payment amount submit settlement information and dispute claims You may modify Account Settings by clicking the appropriate link under the Account Settings list r oa he Update Personal Information To request information regarding a case you have not already associated to your account click the Request Case Update Account Information Access link below Designee Maintenance View Account Activity Change Password To see cases that you have previously associated to your account click the Case Listing link below Request Case Access Case Listing Privacy Policy User Agreement Rev
141. pter 11 Manage Case Access Account Manager The Account Manager is the only user that will be able to see this option The Account Manager will grant or revoke the Account Designee s access to specific case IDs Manage Case Access for Designees 1 Login to the MSPRP site through the Welcome to the MSPRP page using your Account Manager Login ID Enter your User Name and Password in the fields provided Then click Login Welcome to the MSPRP The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request sn updste conditions payment amount submit settlement informastion and dispute claims Forgot ID Getting Started Password If you sre a Medicare Beneficiary and would like to use the MSPRP to request case informstion please login to your gt pre 5 Forgot Password MyMedicare account by visiting the MyMedicere gov website at https mymedicare gow Clea For more informastion refer to How To Get Started under the How To menu option To begin the registration process Login click the New Registration button STEP 1 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement 2 The Welcome page displays This page functions as the main processing page to initiate any MSPRP functions
142. re you can view information using the following options Associated Account ID Update Personal Information Change Password Request Case Access Case Listings View Account Activity Help About This Page 3 Click the necessary Associated Account ID from the Account List home page to Request Case Access and Case Listing information for the selected account for example click 99999 The Welcome Page is displayed Note To view or update Account Settings click Update Personal Information or Change Password Refer to the appropriate sections below to continue this process Skip Navigatior Account List Home About This Site CMS Links ow To aterisls Co s Logoff Help About This Page Account Settings Associated Account IDs Update Personal Information 99999 Click the desired link to access the associated account You may update your personal information or change your current password by clicking the appropriate link under the Account Settings List Change Password Privacy Policy User Agreement SS amp kk LEE Seer Rev 2012 1 July Page 97 MSPRP User Manual Chapter 8 Account Designee Request Case Access The Welcome Page is displayed The Account Representative s name and associated Account ID are displayed As the Designee you are allowed to view information about cases associated with the Account Representatives account ID This page allows you to select Request Case Access C
143. rene en E EEEREN SERRER E E R ENE ENARE 96 R guest Case ACCESS edeseeiorsnieriniesi s nsere Nea N TEE EERE EEEE EEEIEE EEEE ENESE NNE 98 View Account ACUVILY sensies aiae e a a a a ai ai a 99 Rev 2012 1 July Page 2 MSPRP User Manual Table of Contents Case CISNA E nag bcas E A A me E E N 100 Update Personal Informations s cci sicscccesncgadtiaseieetecasesdiyaeecas Spseseanl wud E E EEEE E E EE 101 Change Passw Ord is c2issc cccsedevectotessvitsscdvanteleziac ladetuedelasesystexdvesdaisinavsisderaedolasserssevbuved ddebwoedsadevacde lewastts de 103 Chapter 9 Beneficiary Logim to MSPRP wescssicogessccsices ss scczessapsseastacbuessscsedenesscurcesaagacag costes E EENE EE 104 Login through MyMedicare Go To MSPRP Button eeeceesseeseceeeeseeeecesecaeeereesecaeeeeeeeecaeeaeeseeeaeeas 105 Login through MyMedicare Case ID cee cee ceeccesceeeeeeeeeseeeseeesaecaaecsaecaeceaecsseeeseeseeesseeseaeseneeeaeeenaeenaes 106 MSPRP Case Information Page esiceccecsiescdisjenscienesssetsbesaes tap vaaseag EE EEE E renee 106 Request an Update to the Conditional Payment Amount ee eee eeeeseeeneeeececeeceaeceseeeeeseesseeseneeees 108 Request a Copy of the Conditional Payment Letter 0 eee eeeeneeeneeeeeeaecaeceaeceseceaeeseeesseeseeeeees 108 View Dispute Claims Listing Beneficiary 0 ee cee eeceeceeeceseeeeeeeeneecaeecaeecaaecaaecaeesaeeeaeenseeeneeeseeees 109 Provide the Notice of Settlement Information cei eeceeseeeeeeeseeeseee
144. request a POR or CTR If you are the beneficiary or the Case Debtor this option is not available e Request an update to the conditional payment amount o This option will allow the user to request the system to retrieve all additional medical claims and determine what should or should not be associated to the case This option is not available if there is a pending claim dispute submitted via the MSPRP for the case or if the case is in one of the following statuses Claim Retrieval Demand Bill Issued Closed e Request a copy of the conditional payment letter o This option will allow the user to request a copy of the last conditional payment letter This option is not available if the case is in one of the following statuses Claim Retrieval Demand Bill Issued Closed e View Dispute Claims Listing o This option will allow the user to view and dispute all claims associated to the case This option is only available to beneficiaries and entities with verified POR authorization levels This option is not available if the case is in one of the following statuses Claim Retrieval Demand Bill Issued Closed e Provide the Notice of Settlement Information o This option will allow the user to submit Notice of Settlement information for Liability and Workers Compensation cases only It is available to beneficiaries and entities with verified Rev 2012 1 July Page 140 MSPRP User Manual Chapter 10 Request Case Access POR
145. required Privacy Policy User Agreement 2 The Welcome page displays This page functions as the main processing page to initiate any MSPRP functions Rev 2012 1 July Page 142 MSPRP User Manual Chapter 10 Request Case Access Welcome Navigste to field descriptions Link opens The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and in a new window provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims You may modify Account Settings by clicking the appropriate link under the Account Settings list To request information regarding a case you have not already associated to your account click the Request Case Update Resonel information Access link below Update Account Information Designee Maintenance To see cases that you have previously associated to your account click the Case Listing link below View Account Activity Change Password Request Case Access Case Listing 3 Click Case Listing The Case Listing page is displayed Rev 2012 1 July Page 143 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal Case Listing MO waar Help About This Page The following are the case inquiries associated to Account ID 31036 To view case d
146. ress P cone O oao Privacy Policy User Agreement Rev 2012 1 July Page 44 MSPRP User Manual Chapter 5 Login to the MSPRP Site 3 The Forgot Login ID or Password page displays Answer the two security questions with information you provided during the registration process Correctly answer each of your pre selected security questions Then click Continue If the information you entered is correct your Login ID will be sent via E mail If you receive an error indicating that the answers are incorrect check your answers and enter the information again If you cannot remember the answers to your security questions amp i Ay contact an EDI representative 4 Help About This Page Forgot Login ID or Password An asterisk indicates a required field Security Question 1 What is your favorite beverage Answer 1 Security Question 2 Who is your favorite entertainer Answer 2 ea am gt Cancel J Privacy Policy User Agreement Rev 2012 1 July Page 45 MSPRP User Manual Chapter 5 Login to the MSPRP Site 4 The Forgot Login ID Confirmation page displays if your answers are correct This page confirms that you have successfully requested your Login ID T a Forgot Login ID Confirmation Quick Help Help About This Page You have successfully submitted a request to have your Login ID sent to you Next Steps You will receive an e mail onc
147. rporate Name AAAA First Name AAAA MI A Last Name AAAA Business Mailing Address Title AAAA E Mail Address AAAAAAAAAA Address Line 1 AAAAAAAAAA Ad Line 2 AAAAAAAAAA Phone 442332 ext City AAAAAAAAAA Fax eee State AAAAAAAASAA Zip Code P conve 6 ooa a Privacy Policy User Agreement Rev 2012 1 July Page 60 MSPRP User Manual Chapter 7 Account Settings for Account Manager 9 The Corporate Information Update Confirmation page is displayed The Corporate information has been updated Click Continue to return to the Welcome page Corporate Information Update Confirmation Dan Print tls page Help About This Page The corporate information has been updated Click the Continue button to return to the Home Page Print this page for your records Account Type Corporste Corporate Information Eai Account Representative AR Information Employer Identification Number EIN HHHHHHE Corporate Name AAAAAAAAAA First Name AAAA MI A Last Name AAAA Business Mailing Address Title AAAA E Mail Address AAAAAAAAAA Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA Phone H55 ext HH City AAAAAAAAAA Fax sHHHHHEEE State AAAAAAAAAA Zip Code 4 oem gt Cancel E Privacy Policy User Agreement You can now perform another action from the Welcome page or click Logoff to exit the portal Rev 2012 1 July Page 61 MSPRP User Manual Chapter 7 Account Settings for
148. rs Compensation Medicare Set Aside Portal WCMSAP application Rev 2012 1 July Page 6 MSPRP User Manual Chapter 1 Introduction Electronic Data Interchange EDI Representative Support Users of the MSPRP may need assistance with managing an account or managing their personal information within the application If necessary you may contact an EDI representative for such assistance Contact an EDI representative if the Account ID and PIN letter is not received within 2 weeks 10 business days after completing the following e New Registration Step 1 The EDI representative can resend the letter allowing you to complete the account setup e Any of the information entered during initial registration can only be changed after the initial registration letter has been received e You have any questions or problems regarding your account at any time during account setup e You forget your Login ID and cannot remember the answers to your Security Questions The EDI representative can resend your Login ID to your registered E mail address e You forget your Password and cannot remember the answers to your Security Questions The EDI representative can generate a temporary Password and send it to your registered E mail Address e You incorrectly entered your PIN 3 times and locked the account The EDI representative can reset the PIN to unlock the account e You have questions about case request errors The EDI representative will work wit
149. s representative is a non corporate MSPRP user This user does not have an Employer Identification Number but will regularly send MSPRP requests You will need the following information e Representative contact information name social security number mailing address E mail address phone Beneficiary last name and first initial Beneficiary Social Security Number SSN or Health Insurance Claim Number HICN Beneficiary date of birth Beneficiary gender To begin the process Account Representatives for both Corporate and Representative Accounts must click Step 1 New Registration on the Welcome to the MSPRP page This will bring you to the Select Account Type page where you can select the type of account you want to register Corporate or Representative Follow the steps below to begin the MSPRP registration process Rev 2012 1 July Page 12 MSPRP User Manual Chapter 3 New Registration Registration Steps for All Account Types To successfully register yourself or your organization in the MSPRP application and create an Account ID follow the steps outlined below 1 Enter the following URL into your Web browser https www cob cms hhs gov MSPRP 2 The Login Warning page displays detailing the Data Use Agreement DUA Review the Data Use Agreement DUA To proceed click the Accept link at the bottom of the page You will be denied access to the MSPRP site if you click I Decline The Login Warning page can be pri
150. scescysstessergebcgetng anc stueeueses a a eea EE EEE A E S 145 Chapter 12 SiSmOle yrs cccesceastuss decay enea ien E ie AEEA R EAE OEE AE E E aE 149 Chapter 13 Troubleshooting sensorcirccensiriciioniisorreniinia unano iranin iaeiae a eeni ia eieh 150 Replace Account RepresentatiVesierosntusiisssireirrrnieieioie iseken roeie sedea E Eesi Ee e e esaeo ENDEs 150 Replace Account Manager scsneccisienociienennnni a i i i a a 150 Unsuccessful Account Registrationies csccoc cscecaiscceeessecsredsnecscrassscavtvsbicassesccesveasseassadeoscovtlosscassnanssdeebaneceds 150 Previously Used EIN erenn anena E E E E sa case E O 150 Previously USEd SSN itis cdesseceevscavish seca eea aee Ae RAe E EAE ENEE ETE Ea E E iE EEEE 150 Unsuccesst l Account Setup ccseissivssnvssscdissasseesdech ea e aaa ia ia A Aa AE iaa EAS 150 Account ID Already Resistered acs soerironiirseri ier isie eana EE EOR E AEE SEEEN E RERE EEEN RE 151 Account Manager and Account Representative E mail Addresses Match neseeeseeereerreresrrersree 151 Unsuccessful Account Designee Invitation eeeeseeseeseereeseessstesresttsresrrsesrtssterisstestestesesttssesrissresesteet 151 Account Designee E mail Address Matches Account Representative or Account Manager E mail VAE E E EIEE E E T ET E E TA E EE I EE 151 Account Designee E mail Address Matches Account Designee Already Associated with the Account E ARE ENPE EAE A L EEE TAT TA E EEE A S T E cae 151 Unsuccessful Account Designee Registrati
151. se should be a short case sensitive phrase of your creation Enter a word or words up to 30 characters After you complete the invitation process contact your Designee and provide them with the Passphrase They will need to enter it exactly as you did when they follow the link in their invitation E mail to register for the MSPRP This ensures that only the people you invite will have access to your account Do not share this Passphrase with anyone else It will not be sent to the Designee in the invitation E mail You must give it to them outside the system Then click Continue Reference Materials Designee Invitation ADD cscs rim this page Help About This Page Please provide the name and a psss phrase for the designee to enter during the registration process An asterisk indicates a required field Designee First Name Designee Last Name Passphrase Re enter Passphrase conve Oe Privacy Policy User Agreement Field Description Designee First Name Enter the Designee s first name Designee Last Name Enter the Designee s last name Passphrase Enter a passphrase that you will assign to the Designee Re enter Passphrase Enter the assigned passphrase a second time for verification purposes Command Buttons Previous Click to return to the Designee Information page Continue Click to save changes and continue to the next page Cancel Click to cancel changes an
152. seecsaecaaecsaecsaeesseesseesseesseesees 114 Chapter 10 Request Case ACCESS lt i sccasscsssvcosesarecansevaeust oc shedsnadsbensts cavttalocasvbatccsveasuaavbedess Covtlsbeces sas i 115 Request Case ACCESS segiornu EEEE EE A E heel E E 115 New Case REQUEST saistise icseassesesett ioeie aea ee nE EEEE EA AEEA RERE e NAEVIA S IERE SEEEN ASEE ETES AR 117 Case IMPOTMAU ON pie xg lestcenk sleveetesvsses cen caties ce vecansteteuetiegetseupbes vadetssubigabessestadenbbetaysdaberesssldeseuceiveossdees 118 View Request Authorizations Proof of Representation or Consent to Release cee ceeeeeeeeeeeeees 120 Request an Update to the Conditional Payment Amount eee eeeeseeeneeeeeeceeeceaeceaeceeeesseesseeeeneeees 126 Request a Copy of the Conditional Payment Letter 0 ee eee eeeeseeeeeeeecaeecaeceaecnaeceaeeneeeeeeseeeeees 128 Vaew Dispute Claims LASINE ssiisiedstysnceshevaseegstetese tiptendes Spbstecssteosi EE aE ne sngetaaesh Sesame eee 130 Provide the Notice of Settlement Information cei ceeceeceseeeeeeeeeeeseeeseecsaecaecsaeesaeesseeseesseesseesees 134 Help About This Page Case Information Page 0 0 ceeeeccsseeeseeeeeeeseecaeecaeecaeceaeesaeesseeeeeeseeeeeeeees 139 Case EAS tM Oi seed nctaiuh ang cade cbt A veer tht cave tu Ruanuace vee E NEETA ea EEE a EE E E A EEEE 142 Chapter 11 Manage Case Access Account Manager ceseessesssecsseceseceseceseceseceseeeeeeeseeeeaeesaeeeneeenaeenaes 145 Manage Case Access for Desismees s
153. sphrase Re enter Passphrase Regenerate token Check this box if another invitation e mail must be sent to the Designee TE gt Cancel lancet E Privacy Policy User Agreement Field Description Designee First Name The Designee s first name will automatically be displayed Designee Last Name The Designee s last name will automatically be displayed The Designee s E mail address will automatically be displayed Designee E mail Address The Designee s E mail address will not be displayed in this field You will need to re enter the Designee s E mail address for verification purposes Make sure that this E mail address is the same as the E mail address entered into the field above Re enter Designee E mail Address Passphrase The Designee s passphrase will automatically be displayed Rev 2012 1 July Page 81 MSPRP User Manual Chapter 7 Account Settings for Account Manager The Designee s passphrase will not be displayed in this field You will need to re enter Re enter Passphrase the Designee s passphrase for verification purposes Make sure that this passphrase is the same as the passphrase entered into the field above Regenerate token Check this box if another invitation Select this checkbox to regenerate the token and invitation email This information will e mail must be sent to the be sent to the Designee for login to MSPRP Designee
154. splayed Beneficiary Medicare number Beneficiary date of birth Beneficiary last name Conditional Payment Letter Mail Date Date that the conditional payment letter was sent out to the requestor Current Conditional Payment Amount Conditional Payment Amount was updated on Authorization Level Authorization Status The current conditional payment amount that the debtor owes Note You can request an Update to the conditional payment amount so the most recent amount is displayed on the screen Last date the conditional payment amount was updated There are two types of authorization levels Proof of Representation POR and Consent to Release CTR For more information refer to the section Help About This Page Case Information below This field describes the status of your authorization level There are 3 status types available Verified Unverified and Invalid For more information refer to the section Help About This Page Case Information below Demand Letter Mail Date Date that the demand letter was sent out to the debtor Demand Amount Full amount owed by the debtor Requesting Case Information Table You can select an option from the following list If the option is not active it may not be available for this case Action View Request Authorizations Request an update to the conditional payment amount Request a copy of the conditional payment letter This
155. ss click the New Registration button STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement 4 For Corporate and Representative accounts click Step 1 New Registration Note If you are a Beneficiary click the https mymedicare gov link and use your established Login ID and Password for that application Access to the MSPRP is available from the MyMSP section of the Web site Proceed to Chapter 10 Beneficiary 5 The Select Account Type page displays Select either Corporate or Representative Refer to information available on the MSPRP under How To for more detailed information The Medicare Secondary Payer Recovery Portal MSPRP Registration Guidelines and Scenarios can assist you with making this decision e Corporate Account Type This representative is registering as a corporate entity with an Employer Identification Number EIN Those registering as a Corporate account type will regularly submit MSPRP requests e Representative Account Type This representative is a non corporate MSPRP user This user does not have an EIN but will regularly submit MSPRP requests Rev 2012 1 July Page 14 MSPRP User Manual Chapter 3 New Registration Select Account Type ma Print mis page Help About This Page Plesse select the type of account for which you sre registering Corporate A corporste account type indicstes that the entity has a
156. ss to determine if they are Claim Retrieval related to this case Demand Your bill demand is currently being processed or has been issued f A bill has been issued for the Fixed Percentage Option or Self Calculated Conditional Bill Issued Payment Option Closed The case has been closed If you feel that this is in error please contact the MSPRC at 866 677 7220 to speak with a customer service representative Authorization Levels Authorization Description Having a POR means that a beneficiary has authorized the individual or entity including an attorney to act on the beneficiary s behalf The representative has no independent standing but may receive or submit information requests on behalf of the beneficiary including responding to requests from the MSPRC receiving a copy of the recovery demand letter if Medicare has a recovery claim and filing an appeal if appropriate when that beneficiary is involved in a liability workers compensation or auto no fault situation Proof of Representation POR Having a CTR means that a beneficiary has authorized the individual or entity to receive Consent to Release CTR certain information from the MSPRC for a limited period of time the release does not give the individual or entity the authority to act on behalf of the beneficiary Authorization Status Information situs O Deseo O This field describes the status of your authorization level Your auth
157. sted Account ID In the Enter the Passphrase field type in the phrase given to you by the Account Manager Note The Passphrase is case sensitive Enter it exactly as it was given to you Review the User Agreement To proceed click the Accept the User Agreement and Privacy Policy above box at the bottom of the page You will be denied access to the MSPRP registration process if you do not select this option 6 The Designee Personal Information page displays The Designee s first and last name should be displayed Enter the requested information in the fields Then click Continue Rev 2012 1 July Page 91 MSPRP User Manual Chapter 8 Account Designee Medicare Secondary Payer Recovery Portal Reference Materials Designee Personal Information Gyre oes First Name MI Last Name E mail Address AAAAAAAA Phone H ext Mailing Address Address Line 1 Address Line 2 City State Please Select z Zip Code Privacy Policy User Agreement Field Description First Name Enter your first name MI Enter your middle initial optional Last Name Enter your last name E mail Address Enter your personal E mail address Enter your personal phone number Enter the extension for your phone number optional Address Line 1 Enter the first line of your company mailing address Address Line 2 Enter the second line of your company mailing address option
158. stered on the MSPRP An Account Manager can only view personal information for Designees in Active status 1 On the Home page click the Designee Maintenance link in the Account Settings box Account Settings Update Personal Information Update Account Information Designee Maintenance View Account Activity Change Password 2 On the Designee Listing page click the last name of the Designee whose information you wish to update Designee Listing Print tls page This page provides the Designee s information for the individuals you have assigned to the account An Account Manager can only make changes to a pending Designee Once the Designee has registered and has a Login ID the Account Manager cannot make changes to the Designee information other than deleting the Designee from the account To make changes to the account of a particular Designee listed select the link on the individual s last name To delete a Designee select the Delete function to the left of the individual s name Use the Add a Designee function to include an individual ss a designee Individuals added ss designees will receive an e mail notifying them thst they have been invited to be a designee for the account Selecting Cancel will return you to the Home Page Delete Last Name First Name E mail Address Passphrase Status x AAAA AAAAA AAA AAA AAA AAA AAA AAA AAAA 3 The Update Designee Information page displays with the
159. tage Option Completion of this page will result in the issuance of a demand bill Note if you believe any of the claims listing on the Claims Listing Page are unrelated to the case click Cancel and select the View Dispute Claims Listing option to submit a dispute Please do not submit a dispute as part of the settlement documentation An asterisk indicates a required field Injury Type Traumatic Injury e g Slip and Fall or Auto Accident Non traumatic Injury e g Alleged injury resulting from exposure implantation or ingestion of a substance Settlement Amount p 0 00 999 999 999 00 Settlement Date 1 MMIDDICCYY Settlement Details Please choose one of the following options Note If nothing is entered this request will be processed without Attorney Fees None Attorney Fees What are Attorney Fees Attorney Fees 0 00 999 999 999 00 Attorney Expenses x 0 00 999 999 999 00 Attorney Fee Percentage Fixed Percentage Option Whatis Fixed Percentage Option Exclusions MED PIP Other Exclusions j 0 00 999 999 999 00 What are Exclusions V attest that the settlement information provided above is correct Official Settlement Documentation court documents is not required unless needed to resolve relatedness issues on conditional payments made In certain situations CMS may require a detailed breakdown of attorney fees and expenses to be provided uploaded
160. the HICN you should NOT enter an SSN Beneficiary Social Security Number SSN Beneficiary Date Of Birth Beneficiary Gender Command Buttons Previous Continue Cancel Enter the beneficiary s SSN If you enter the SSN you should NOT enter a HICN Enter the beneficiary s date of birth Select the beneficiary s gender from the drop down list Click to return to the Representative Information page Click to save changes and continue to the next page Click to cancel the registration process Information entered on the current page and any previous pages is NOT saved Rev 2012 1 July Page 23 MSPRP User Manual Chapter 3 New Registration 3 The Registration Summary page displays This page lists all the information that was previously entered All information should be reviewed and verified before continuing Medicare Secondary Payer Recovery Portal Registration Summary Quick Help Help About This Page Please review your registration information If you need to change the information click the Edit button If you are satisfied with the information click the Continue button to submit the registration Click the Cancel button to cancel the process Please note all data will be lost Click the Previous button to return to the previous screen Print this page for your records Account Type Representative Eai Representative Information Eai Beneficiary Information Ea First Name AAAA MI
161. the event of authorized law enforcement investigations and pursuant to any required legal process information from these sources may be used to help identify an unauthorized individual who has accessed uploaded changed or attempted to access upload or change information through this site and may be used for administrative criminal or other adverse action So that the CMS Web site remains accurate and available to you and all other visitors we monitor network traffic to identify unauthorized attempts to upload or change information or otherwise cause damage to the web service Use of this system constitutes consent to such monitoring and auditing Unauthorized attempts to upload information and or change information on this web site are strictly prohibited and are subject to prosecution under the Computer Fraud and Abuse Act of 1986 and Title 18 U S C Sec 1001 and 1030 http Avww cms hhs govw About CMS Agency Information AbDoutwebsite Security Protocols html Privacy Act Statement The collection of this information is authorized by Section 1862 b of the Social Security Act codified at 42 U S C 1395y b see also 42 C F R 411 24 The information collected will be used to identify and recover past conditional and mistaken Medicare primary payments and to prevent Medicare from making mistaken payments in the future for those Medicare Secondary Payer situations that continue to exist The Privacy Act 5 U S C 552a b as amended prohib
162. the provided fields Then click Continue Medicare Secondary Payer Recovery Portal About This Site Reference Materials Corporate Information An asterisk indicates a required field Help sbout this page Identification Number 2 EIN Corporation Name Business Mailing Address Address Line 1 Address Line 2 City State Select Zip Code cea Privacy Policy User Agreement Corporate Information Page Field Description The IRS assigned 9 digit Employer Identification Number EIN Taxpayer Employer Identification Identification Number TIN associated with the organization If you have more than Number EIN Taxpayer one EIN TIN you may submit this registration with any one of those EINs TINs Note Identification Number TIN This cannot be edited after registration Corporation Name Enter the company name Address Line 1 Enter the first line of the company s mailing address Address Line 2 Enter the second line of the company s mailing address optional City Enter the city where the company is located Rev 2012 1 July Page 16 MSPRP User Manual Chapter 3 New Registration Select the state where the company is located from the drop down list stale Note To quickly select a state type the first letter to scroll to the desired state Zip Code Enter the company s zip code required plus 4 digit zip code su
163. tter that you received before and view and dispute claims For a description of the case actions that can be performed using the Case Information page see the tables below Or refer to the Help About This Page Case Information section in Chapter 10 Request Case Access 1 The Case Information page is displayed Select the necessary option from the list of actions Then click Continue Medicare Secondary Payer Recovery Portal About This Site CMS Links Reference Materials Contact Us Case Information Quick Help Help About This Page Case ID 99999 99999 99999 Rights and Responsibilities Letter Mail Date Case Type Liability Case Status OPEN What is this Beneficiary Medicare Number 99999 Conditional Payment Letter Mail Date Beneficiary DOB 99 99 9999 Current Conditional Payment Amount 999 99 Beneficiary Last Name AAAA Conditional Payment Amount was updated on 99 99 9999 Demand Letter Mail Date Demand Amount 0 00 Please select an action from the following list if the option is disabled it may not be available for the case at this time Cc Request an update to the conditional payment amount What is this Request a copy of the conditional payment letter What is this Cc View Dispute Claims Listing What is this Provide the Notice of Settlement Information 2T Privacy Policy User Agreement Field Description Case ID The beneficiary case ID is displayed Case Type The typ
164. tton to return to the Home Page all changes will be lost Account Type Representative Beneficiary Information Representative Information Eai First Name FIRST MI M Last Name LAST Last Name LAST First Initial F SSN 7 338 cee E Mail Address AAAA AAA AAA Phone 8HHRHHHH ext Date of Birth AAAA F HHF Fax sti HHH G da AAAA Representative Mailing Address Eai Address Line 1 AAAAAAAAAA Address Line 2 AAAAAAAAAA City AAAAAAAAAA State AAAAAAAAAA Zip Code 332 eam gt Cancel Privacy Policy User Agreement 3 Inthe Update Representative Information page make changes as necessary Note You must re enter the email address in the Re enter E mail Address field before you can continue to the next page Then click Continue to save your changes and return to the Update Account Information page Rev 2012 1 July Page 63 MSPRP User Manual Chapter 7 Account Settings for Account Manager E mail Address Reference Materials Update Representative Information gt Print tis page An asterisk indicates a required field First Name MI Last Name E mail Address Re enter E mail Address Phone ext Fax Mailing Address Address Line 1 Address Line 2 City State Zip Code __ Caneel 3 Field Description First Name Enter your first name MI Enter your middle initial optional Last Name Enter your last name Enter your personal E mail address
165. ttons Continue Click to save changes and continue to the next page Cancel Click to return to the Case Information page If necessary upload supporting documents for the settlement by clicking the Upload Documentation link Note The document must be in Adobe Acrobat pdf format 6 Click Browse to locate the document you want to upload Note The document must be in Adobe Acrobat pdf format Then click Continue Or click Cancel to return to the previous page without uploading any documents Rev 2012 1 July Page 136 MSPRP User Manual Chapter 10 Request Case Access Medicare Secondary Payer Recovery Portal l Notice of Settlement Documentation Upload TOE Help adout Mis page Please click Drowse to find he document The document must be in PDF format and the size imit is 40 MB megabyte per document for attachments Selecting Continue will upload the documents Selecting Cancel will retum you to the Setement information page and documents wall not de uploaced E oe a 7 The Settlement Information page is displayed again The document you uploaded will be listed Note To delete uploaded documents click on the Delete link next to the document name The document will be removed from the supporting documentation list 8 Click Continue confirm submission The Confirmation page is displayed Click Continue to return to the Settlement Information page 9 When you have entered the necessar
166. ty AAAAA State AAAA Zip Code 4HH HH Print mis page The MSPRP Welcome page is displayed Skip Navigatio Home About This Site CMS Links How To R jaterials Welcome The Medicare Secondary Payer Recovery Ports provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims You may modify Account Settings by clicking the appropriate link under the Account Settings list To request information regarding a case you have not already associated to your account click the Request Case Access link below To see cases that you have previously associated to your account click the Case Listing link below Request Case Access Case Listing Privacy Policy User Agreement Update Personal Information Updste Account Information Designee Maintenance View Account Activity Change Password Rev 2012 1 July Page 66 MSPRP User Manual Chapter 7 Account Settings for Account Manager Designee Maintenance For Corporate and Representative Accounts the Account Manager may designate one or more Account Designees to assist with case submission and management Note If you are adding the same Designee to multiple accounts the Designee will receive multiple email invitations T
167. uick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims Getting Started User Name Forgot ID Password If you are a Medicare Beneficiary and would like to use the MSPRP to request case information please login to your Forgot Password MyMedicsre account by visiting the MyMedicare gov website at https mymedicare govw For more information refer to How To Get Started under the How To menu option To begin the registration process Losin Clea click the New Registration button STEP 1 STEP 2 New Registration Account Setup Account ID and PIN required Privacy Policy User Agreement 3 In the Sign in to your account box enter your Login ID in the User Name field and your Password in the Password field Then click Login Or click Clear to remove the information entered in the User Name and Password fields Rev 2012 1 July Page 42 MSPRP User Manual Chapter 5 Login to the MSPRP Site 4 The Welcome page displays This page functions as the main MSPRP home page where you can process or initiate any MSPRP functions Refer to Chapter 6 MSPRP Welcome Page After Successful Login for more information Welcome The Medicare Secondary Payer Recovery Ports provides s q
168. uick and efficient way to request case information snd provide information to assist in resolving Medicare s recovery daim With the use of this portal you may submit a valid suthorization request an update conditional payment amount submit settlement information snd dispute claims You may modify Account Settings by clicking the sppropriste link under the Account Settings list Update Personal Informstion To request information regarding a case you have not already associated to your account click the Request Case Access link below Update Account Information Designee Maintenance To see cases that you have previously associated to your account click the Case Listing link below View Account Activity Change Password Request Case Access Case Listing 5 Now you can select an option from the Account Settings section as necessary Rev 2012 1 July Page 43 MSPRP User Manual Chapter 5 Login to the MSPRP Site Forgot User Name Login ID If you forgot your user name login follow the steps below 1 On the Welcome to the MSPRP page click Forgot ID below the User Name field Forgot ID 2 This displays the Forgot Login ID page Enter your E mail address and click Continue Or click Cancel to stop and return to the Welcome to the MSPRP page without requesting a new Login ID p Forgot Login ID EN Print this page Help About This Page An asterisk indicates a required field Enter your E mail Add
169. unt Manager Rev 2012 1 July Page 99 MSPRP User Manual Chapter 8 Account Designee Case Listing The Case Listing link will allow you to retrieve and manage submitted case requests 1 From the Welcome page click Case Listing The Case Listing page is displayed Here you can see the list of recovery Case IDs available to you You can search for a case ID by entering information into one or more fields Click Search to find the specified case Or click Cancel to return to the Account List page Medicare Secondary Payer Recovery Portal Case Listing PORS The following are the case inquiries associated to Account ID 31036 Help About This Page To view case detail information click the case number To manage Designee access to the case click on the Manage Access link To perform a search enter the search criteria and click the search bution ReMAS Case I0 Beneficiary HICN oR Beneficiary SSN Selecting Cancel will return to the Home Page Cases ReMas Case ID Bene HICWSSN Bene Date of Birth Case Access Bene Last Name 9999999999 999 AAAA ad 9999999999 999 AAAA Cancel 3 Rev 2012 1 July Page 100 MSPRP User Manual Chapter 8 Account Designee Update Personal Information This page allows you to update or change your personal information such as E mail phone number and mailing address 1 From the Account List page click Update Personal Information in the Account Settings
170. uracy To revise your selection click the Previous bution Claims Disputed Claim Control I0 ICN poo Total Charges Reimbursed Amount Conditional Payment se 9999999 1 205 00 77 05 77 05 ee 9999999 2 165 00 56 09 56 09 Supporting Information amp Documentation Please provide a Drie description of the injury and explanation for any daims you disputed as unrelated to the case E you have more than one explanation please provede the date range for each explanation Example Claims with the dates between January 1 2010 and September 13 2010 were for beck surgery Dut this case is for a sprained knee Enter text here a Please note Supporting Information Notes cannot exceed 500 characters For disputes that require additional information please upload supporting documentation Examples of when supporting documentation should be uploaded include providing clarification of incident related injuries proving a pre existing COMADON OF establishing incident end date of reatment Upload Documentation To upload supporting documenation please click here Below ts a list of documents to be submitted for the case If you d like to delete a document fom ihe list click he Delete link to the right of he document name AAAAPDF Doleto Select Continue to confirm submission of the dispute and to submit any provided documents fo CMS Selecting Previous wilt return you to the View Dispute Claims Listing page Selecting Cancel will retum y
171. will not be allowed to register for a different account An Account Manager is only allowed to be sssocisted to one account During this process you will Finalize the establishment of the account and Create your personal Login ID for the MSPRP Before proceeding it is important to understand the roles of the various MSPRP users and their respective responsibilities to ensure the MSPRP accounts are managed corectly The role of the Account Manager is described below Account Manager The Account Manager is the MSPRP user who is required to initiste the request for an account They sre the person who administers the account on the Web site on behalf of the registrant The Account Manager is the person who is responsible for establishing the account on the Web Portal managing the case load and assigning some or all of the cases to other responsible parties to complete on the MSPRP tracking the status of the tasks sssigned to others and ensuring case entry snd submission sre completed on time The Account Manager is responsible for inviting other employees to register on the Web Portal and managing their access The Account Manager may complete and submit cases on his own or invite Designees to assist as needed If your user role in the MSPRP is an Account Manager ss described above and you have not yet registered press the Continue button and proceed with registering as a new Account Manager eT ae gt Cancel Privacy Policy
172. y Portal About This Site How Te Reference Materiak Welcome Help About This Page The Medicare Secondary Payer Recovery Portal provides a quick and efficient way to request case information and provide information to assist in resolving Medicare s recovery claim With the use of this portal you may submit a valid authorization request an update conditional payment amount submit settlement information and dispute claims You may modify Account Settings by clicking the appropriate link under the Account Settings list To request information regarding a case you have not already associated to your account click the Request Case Access link below To see cases that you have previously associated to your account click the Case Listing link below Request Case Access Case Listing Privacy Policy User Agreement Rev 2012 1 July Page 105 MSPRP User Manual Chapter 9 Beneficiary Login through MyMedicare Case ID MSPRP Case Information Page This page provides details about the case such as case ID type status beneficiary information letter mail date current conditional payment amount and demand letter date This page allows you to request information add to the list of authorized people who can view or request information about the case Proof of Representation POR or Consent to Release COR request an update on the conditional payment amount request another copy of the conditional payment le
173. y information in the Settlement Information page click Continue The Notice of Settlement Confirmation page is displayed You can print this page by clicking on the Print this page link Or click Continue to return to the Case Information page Rev 2012 1 July Page 137 MSPRP User Manual Chapter 10 Request Case Access Notice of Settlement Confirmation Help Adout This Page Case ID 99999 99999 Beneficiary HICN 9999 4 Beneficiary Last Name Maley You have successfully submitted the Notice of Setement documentation for the case listed above ASDA PDF Click Continue to return to he Case information page You have now completed this process Rev 2012 1 July Page 138 MSPRP User Manual Chapter 10 Request Case Access Help About This Page Case Information Page All pages in the MSPRP system contain a Quick Help section with the Help About This Page link On this page you will find the latest information the MSPRC has on file for the case selected Based on your case status and authorization level you will also be able to request actions to be taken on a case This section provides information and details about the Case Information page fields options and available status Case Status Descriptions Case Status Description In Development The case is currently in the development process Open The case is currently open and in an active status Claims are currently being retrieved or in the review proce
174. your Account Manager does not remember the Passphrase they can log into the MSPRP site and create another Passphrase by accessing the Designee Maintenance page and selecting the details Rev 2012 1 July Page 151 MSPRP User Manual Chapter 13 Troubleshooting associated with your last name They can then provide the correct Passphrase to you The Passphrase is case sensitive Unsuccessful Login Invalid Login ID Refer to Chapter 5 Inactive Login ID If you receive this error message at login your access to the MSPRP site has been deactivated due to inactivity in the last 180 days Contact an EDI representative to reactivate your Login ID and create a new Password Revoked Login ID If you receive this error message at login you can no longer access the MSPRP site Invalid Password Refer to Chapter 5 Expired Password Refer to Chapter 7 Deleted Account If you receive this error message at login your account s Account ID has been deleted It has been deleted because a signed Profile Report has not yet been received by Medicare and 61 business days have elapsed from the date the Profile Report was sent Your account must go through the Registration and Setup processes again to gain access to the MSPRP site Case Request Errors For any additional problems contact the COBC EDI Department at 646 458 6740 or by E mail at COBVA GHTMedicare com EDI representatives are available to assist you Monday through Friday
175. zed Representative named in your initial MSPRP registration If you registered for a Corporate Account your Account Manager and Authorized Representative must be different individuals An Authorized Representative cannot be a user on the MSPRP If you registered for a Representative Account when you perform the Account Setup you can indicate that the Account Manager is the same person as the Account Representative The Account Manager is the individual who will administer the account on the MSPRP This includes submitting authorization request requesting conditional payment amounts conditional payment letters submitting claim disputes submitting notice of settlements updating MSPRP account information and inviting others to assist Account Designees Rev 2012 1 July Page 26 MSPRP User Manual Chapter 3 New Registration Account Designee Each MSPRP account may have multiple Account Designees Account Designees may also submit authorization requests request conditional payment amounts request generation of conditional payment letters submit claim disputes and notice of settlements However Account Designees cannot modify MSPRP account information or invite others to assist Account Designees can only register as users on the MSPRP through an invitation from the Account Manager Additional Account Setup Information Please review the documentation regarding information needed for completing your MSPRP registration an

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