Does my letter from the MSPRC cover Medicare Advantage claims?

Question: I have a client that has Medicare Advantage Plan. I filed with the Coordination of Benefits Contractor and received a letter from the Medicare Secondary Payer Recovery Contractor (MSPRC) that no claims had been paid and its file was closed. I know that this specific carrier has paid on claims, but I have not been notified of any subrogation claim. Does the letter from the MSPRC cover Medicare Advantage claims?

Answer: The letter you received from MSPRC does not cover claims that may have been paid for by a Medicare Advantage Plan (Part C) or a Medicare Prescription Drug Plan (Part D). The letter from MSPRC only covers those claims paid for by traditional fee-for-service Medicare (Parts A/B). While Part C and D plans have a contractual relationship with the Centers for Medicare and Medicaid Services (“CMS”), the payment of claims by Part C and D plans and the subsequent secondary payer rights of these plans, are handled exclusively by the individual Part C or Part D plan provider (generally a private insurance company).

In your particular case, the specific carrier you mentioned is a Part C plan offered by BCBS of NC. As a result, the production of claims and resolution of a reimbursement claim would be handled directly with that specific carrier.

To learn more information about Part C plans and potential obligations, please click here.