The same basic range of services is necessary
for resolving both Medicare and Medicaid claims.
However, the services for resolving Medicaid liens
differ somewhat from the services for resolving
Medicare claims due to the fact that Medicaid is
administered by each of the States. In other words,
the process for managing and resolving these respective claims must be adapted to adequately address the administrative reality that Medicare is administered by one Federal agency while Medicaid is administered by a collection of 50 State agencies. In all cases, however, our services consist of what is described in the list below.

We will provide the following services in the MEDICARE Claim Resolution Process:

• Obtain HIPPA compliant releases from the client or referring attorney;
• Verify if the client is receiving, or has received, Medicare benefits;
• Open a case with the Centers for Medicare and Medicaid Services (CMS);
• Request a Conditional Payment Summary from the Medicare Secondary Recovery Contractor (MSPRC);
• Review the initial Conditional Payment Summary for related and unrelated claims;
• Monitor and review any ongoing Conditional Payment Summaries as the case progresses to settlement;
• Dispute any medical claims that are unrelated to the incident;
• Request the final Demand Letter from CMS when the case settles (the total of all claims minus any unrelated claims and minus the procurement costs of attaining the settlement);
• Request a hardship waiver, if applicable;
• Notify the referring attorney when the Demand Letter arrives and provide a reminder that the claim must be paid within 60 days; and,
• Provide payment instructions to the referring attorney so that payment of the claim is properly applied and CMS closes the case.

We will provide the following services in the MEDICAID Claim Resolution Process:

• Obtain HIPPA compliant releases from the client or referring attorney;
• Verify if the client is receiving, or has received, Medicaid benefits;
• Contact the private contractor or state agency that is responsible for processing Third-Party Casualty Claims;
• Request a payment summary of all claims paid through the state’s Medicaid Program;
• Review the payment summary for related and unrelated claims;
• Monitor and review any additional payment summaries as the case progresses to settlement;
• Dispute any medical claims that are not related to the incident;
• Request the final claim from private contractor or state agency when the case settles;
• Notify the referring attorney when the final claim is determined and provide a reminder that the claim must be paid within 60 days; and,
• Provide payment instructions to the referring attorney so that payment of the claim is properly applied and private contractor or state agency closes the case.