CMS Transitions NGHP to CRC

Effective October 2015, the Centers for Medicare & Medicaid Services (CMS) will be transitioning a portion of the Non-Group Health Plan (NGHP) recovery workload from the Benefits Coordination and Recovery Center (BCRC) to its Commercial Repayment Center (CRC).

Effective October 2015, the CRC will assume responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation (WC) entity as the identified debtor. At that time:

•   The transition only includes those cases where CMS is pursuing recovery from the liability insurer, no-fault insurer or WC entity directly, and 

•   Beneficiaries and their attorneys will continue to work with the BCRC where CMS is pursuing recovery from the beneficiary.

Then effective January 1, 2016, CMS will add an additional limitation to Medicare claims payments where insurers or workers’ compensation entities have reported to CMS that they have Ongoing Responsibility for Medicals (ORM).

In situations where an insurer or workers’ compensation entity has reported to CMS that it has ongoing responsibility for medicals (ORM) for specific care, CMS’ claims processing contractors will use the information provided by the insurer or workers’ compensation entity to determine whether Medicare is able to make payment for those claims.

To obtain the full announcement, please click here >>