Rapid Payment Resolution with Big Savings
Conditional Payments and Liens represent medical payments made by Medicare and other health plans that may be the responsibility of a “primary payer”. Recovery can come from many places including the Benefit Coordination & Recovery Center (BCRC), Commercial Repayment Center (CRC), Medicare Advantage Plans, Prescription Drug Plans, and others (Medicaid, Veteran’s Administration, TRICARE, and ERISA). Jorah delivers results with rapid resolution of conditional payment/lien recoveries, consistently achieving significant reductions for our clients.
Conditional Payment Resolution
Conditional Payment (CP) recovery demands come from Medicare’s contractors when there is a claim with open Ongoing Responsibility for Medicals or when a settlement occurs with a Medicare Beneficiary. Jorah’s team has set the industry standard in proactively identifying and resolving these recovery demands at the right time in the claim life cycle. Commonly used services for CP Resolution are as follows:
- Research: Identifies the conditional payment amount and status of the debt.
- Dispute: Analyzes the Demand to file disputes and appeals with the CRC/BCRC to reduce the debt.
- Evaluation: Review Demand to determine if there is a basis for a dispute or appeal.
- Update: On claims that remain open, an updated search will identify any changes in the Demand.
- Final Demand/Case Closure: Secures a Final Demand/Case Closure from Medicare post-settlement.
- QIC/ALJ Appeals: Dispute and Appeal of Demands that need to be handled through the Qualified Independent Contractor (QIC) or Administrative Law Judge (ALJ) process.
- Benefit Coordination: Identifies an individual’s beneficiary status and coordinates benefits when coverage issues are occurring on the claim.
MAP/Part D Lien Resolution
Medicare Advantage Plans (MAPs) and Prescription Drug Plans (Part D) provide coverage to a significant portion of Medicare Beneficiaries. These plans are identifiable to “Primary Plans” in data that is returned to the Responsible Reporting Entity (RRE) in the Section 111 Reporting data feed. Jorah’s team can proactively identify the MAP/Part D Lien(s) to ensure rapid resolution and protect against ongoing recovery efforts post-settlement.
- Research: Identifies the claimed lien amount per plan involved.
- Dispute: Negotiation and resolution of the claimed lien amount per plan involved.
- Evaluation: Review of the claimed lien amount to determine if there is a basis for Dispute.
- Update: An updated search will identify any changes in the lien amount.
Other Lien Resolution
Medicaid, Veteran’s Administration, TRICARE, and ERISA are examples of other types of liens that can be asserted in a claim. Jorah’s Recovery Team can assist in identifying, disputing and resolving these liens to ensure the claimant and parties to the settlement are clear of any ongoing recovery efforts.
- Research: Identifies the claimed lien amount per plan involved.
- Dispute: Negotiation and resolution of the claimed lien amount per plan involved.
- Evaluation: Review of the claimed lien amount to determine if there is a basis for Dispute.
- Update: An updated search will identify any changes in the lien amount.
