Recovery Agent Authorization Model Language

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on October 18, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has released model language identifying those elements that must be included in an authorization request for a Recovery Agent representing an Applicable Plan in Medicare Secondary Payer recovery claim activities. All authorization request documents must include the following elements:

  1. A statement that the Applicable Plan appoints the Recovery Agent to act on its behalf.
  2. The name, address and phone number of each identity (inclusion as part of the letterhead is sufficient).
  3. The relationship between the entities (TPA, Attorney/Client, etc.).
  4. The reason, specifically the purpose and scope, for the authorization.
  5. Reference to the recovery case identification or associated claims information if no identification number has been assigned.
  6. The time frame for the Recovery Agent’s authority.

Additionally, the request for authorization must be in writing and must be signed and dated by both entities. The authorization request must then submitted to CMS’ recovery contractor. Sample letters are available on CMS’ website at: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/InsurerServices/Insurer-NGHP-Recovery.html

While CMS does not require use of the sample letters, all authorization requests must include all of the elements noted above.