Benefits Coordination and Recovery Center BCRC Overview Agenda

Benefits Coordination and Recovery Center (BCRC) Overview

Agenda • BCRC Responsibilities • BCRC processes – Overview of Data Collections process – Overview of Recovery process • BCRC Contact Info • Call Center – IVR Tips – Virtual Hold • Benefits of BCRC • Questions 2

BCRC Responsibilities • • • Determining who pays Medicare claims first Ensuring claims are paid correctly Sharing Medicare eligibility data with other primary payers Avoiding duplicate payments Sending claims data to other insurers Recover when other insurance should pay first 3

How it works BCRC Data Collections Recovery Center Collects information from multiple sources to research MSP situation. Responsible for identifying and recovering Medicare payments that should have been paid by another entity as the primary payer • Section 111 Mandatory Insurer Reporting submissions; Workers Compensation; etc. 4

Overview of the Data Collections Process

How Does BCRC Collect Information? • Self Report (Call, Fax, Mail) – Attorney, Beneficiary, Insurer, Provider, etc. • Medicare Secondary Payer (MSP) Claims Investigations • Prescription Drug Coverage Questionnaire • Data Sharing Agreements (DSA) – DSA – Data Sharing Agreement – COBA – Coordination of Benefits Agreement • Mandatory Insurance Reporting (Section 111) 6

Overview of the DC Process Beneficiary, Provider or Attorney calls to report a GHP, NGHP or request information on COB CSR asks probing questions to determine if beneficiary’s record is accurate 7

Overview of the DC Process Option 1 – Reporting new GHP record CSR collects information (SPD, 411. 25 or PDC) In 24 to 48 hrs. CWF/HIMR system are updated Confirmation letter is sent to beneficiary 8

Overview of the DC Process Option 2 – Reporting new NGHP record CSR collects information (SPD, 411. 25 or PDC) In 24 to 48 hrs. CWF/HIMR systems are updated Confirmation letter is sent to beneficiary 9

Overview of the DC Process Option 2 – Reporting new NGHP record cont. System forwards all NF and WC leads to CRC System receives electronic information and creates a Lead System forwards all Liability leads to BCRC 10

Overview of the Recovery Process 11

Recovery Process Accident/incident/ illness occurs Beneficiary goes to hospital/doctor Hospital/doctor submits claim for payment 12

Recovery Process Medicare makes conditional payments for services Case is reported to BCRC and information is gathered MSP Recovery issues Rights and Responsibilities (RAR) Letter The payment is “conditional” because it must be repaid to Medicare if/when a settlement, judgment, award or other payment is secured 13

Recovery Process The search for Medicare Claims begins Medical claims related to the incident are identified and a Conditional Payment Letter (CPL) is issued Claims may be disputed from the CPL if recipient feels they are not accident related 14

Recovery Process Settlement, judgment, award, or other payment is reached. Notice of Settlement (NOS) must be submitted to the BCRC The final payment amount is identified and a Demand Letter is sent 15

Recovery Process Option 1 - Payment A check is received for demand amount MSP Case Complete 16

Recovery Process Option 2 – Issues Arise A post demand inquiry is sent. (e. g. questions, appeals, request for waiver, etc. ) 17

Recovery Process Option 3 – Intent To Refer Interest is assessed from date of demand if the debt is not resolved within 60 days If full repayment is not received within 60 days, an Intent to Refer Letter (ITR) is issued If Full repayment is not received within 60 days of ITR Letter (120 days of demand), debt is referred to Treasury once any outstanding correspondence is worked 18

Contact Information 19

Contact Information BCRC MSP Data Collection Area Address Data Collection Authorization Data Collections Authorizations PO Box 138898 Oklahoma City, OK 73113 Medicare MSP General Correspondence Medicare-MSP General Correspondence PO Box 138897 Oklahoma City, OK 73113 Medicare MSP Claims Investigation Project Medicare-MSP Claims Investigation Project PO Box 138897 Oklahoma City, OK 73113 Voluntary Data Sharing Agreement VDSA Program PO Box 660 New York, NY 10274 Workers Compensation Set Aside Arrangement Proposal WCMSA Proposal/Final Statement PO Box 138899 Oklahoma City, OK 73113 20

Contact Information BCRC Recovery Area Address NGHP Inquiries/Checks/Recovery Authorizations NGHP PO Box 138832 Oklahoma City, OK 73113 Fixed Percent Option PO Box 138880 Oklahoma City, OK 73113 Special Projects (Product Liability Case inquiries and SP Checks) Special Projects PO Box 138868 Oklahoma City, OK 73116 Self Calculated Conditional Payment Option Self-Calculated Conditional Payment PO Box 138880 Oklahoma City, OK 73113 Overnight Mail – address requests, i. e. subpoenas, checks, etc. BCRC 7608 N. Hudson Ave Oklahoma City, OK 73116 21

IVR Tips • 855 -798 -2627 • First Menu – Beneficiary- Press 1 – Calling about Beneficiary- Press 2 – Commercial Repayment Center- Press 4 – Selection must be made at this menu before pressing “ 0” for an agent 22

IVR Tips • Beneficiary Menu – 800 Medicare transfer- Press 1 – Otherwise Press 2 for BCRC • Complete Authentication via speech recognition (4 pieces) • Successful Authentication – Presented Dynamic Menu based on information on Beneficiary File • Unsuccessful Authentication – Call is transferred to an agent 23

IVR Tips • Other Caller Menu – Provider- Press 1 – RRE- Press 2 – Attorney- Press 3 – Agent, Other Rep- Press 4 – Employer- Press 5 – DSA- Press 6 24

IVR Tips • Authentication will vary based on caller type – For example Provider/RRE • 2 pieces to identify entity • 2 pieces for Beneficiary – Successful Authentication – Presented Dynamic Menu based on information on Beneficiary File – Unsuccessful Authentication – Call is transferred to an agent 25

Self Service Information • Coverage Status – Medicare Primary Versus Secondary – Status on Specific Date • Entitlement Information – Date – Reason • ESRD Information – Date of Dialysis – Coordination Period • Recovery Information – RAR Date – CPL Mail Date and Amount – Demand Mail Date and Amount 26

Virtual Hold • Call Center offers Virtual Hold – Offers to call back while holding place in the queue – Once called back, agent is ready to assist – Saves time by not waiting on hold – Enhances Customer Experience 27

How BCRC Benefits our Customers • Enhanced Beneficiary experience because claims are processed with greater efficiency due to accurate records • Timelier processing of beneficiaries’ medical claims reduces employers administrative expenses • Physician and supplier’s payments increase when Medicare is secondary payer • Reduces cost of recouping payments made in error and ensures integrity of Medicare Trust Fund 28

Questions? 29