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Conditional Payment Letter (CPL) A CPL provides information on items or services that Medicare paid conditionally and the BCRC has identified as being related to the pending claim.
Conditional Payment Letter. • Attorneys can obtain conditional payment information from the Medicare Secondary Payer Recovery Portal (MSPRP) using this link: https://www.cob.cms.hhs.gov/MSPRP. Registration must occur before access to the MSPRP is permitted.
Conditional Payment Letter (continued) • Review the Conditional Payment Letter thoroughly to make sure that only case related claims are included. • Up–to-date Conditional Payment amounts can be accessed on the MyMedicare.gov website. (attorneys will need to gain access through their client).
If payment has not been made or cannot be expected to be made promptly from the other payer, Medicare may make a conditional payment, under some circumstances, subject to Medicare payment rules. Conditional payments are made subject to repayment when the primary plan makes payment or when a settlement, judgment, award, or other payment is secured.
This letter identifies Medicare's current conditional payment amount (as noted in the Current Conditional Payment Amount on the Case Information page) The CPL will include a Payment Summary Form that lists claims paid by Medicare that are being claimed and/or released with respect to the accident, illness, injury, or other incident.
Conditional Payment Letter (CPL) A CPL provides information on items or services that Medicare paid conditionally and the BCRC has identified as being related to the pending claim.
About the Electronic Conditional Payment Letter. This letter identifies Medicare's current conditional payment amount (as noted in the Current Conditional Payment Amount on the Case Information page) for the case.
Are claims submitted to Medicare when primary payer has not paid promptly (accident situation) or for a valid reason. Require OC 24 and date of primary payer’s notice (RA, EOB statement, letter, etc.) explaining why they did not pay claim. Exception: when primary payer for accident did not pay promptly.
A conditional claim can be submitted to Medicare if there is no MSP record on the Common Working File (CWF). For information on how to properly submit a conditional payment claim, refer to CMS IOM 100-5, Chapter 5 (PDF), Section 40.6 for detailed instructions.
This letter identifies the conditional payments that Medicare has made to date that are related to what is being claimed and/or released with respect to the accident, illness, injury, or other incident. It also identifies the total Current Conditional Payment Amount and includes a Payment Summary Form.