Conditional Payment Resolution

Avoid double damages, protect against future liability and minimize exposure to unrelated costs with NuQuest Conditional Payment Products.

To properly comply with the MSP statute, addressing conditional payments should be an integral part of claims handling.

Whether facing liability, Workers’ Compensation, No-Fault, Medicare Advantage or Medicaid claims, considering these issues early in the process allows time to obtain the necessary information, identify and eliminate costly disputable claims, and minimize both carrier and Medicare Conditional Payment exposure.

Benefits

  • Reduces costs – minimizes Medicare’s repayment requests
  • Avoid legal action and double damages – by proactively protecting the interests of Medicare as secondary payer
  • Protect against future liability – by ensuring that the primary payer has taken responsibility for appropriate expenses
  • Minimize exposure to unrelated medical costs- by identifying and eliminating costly unrelated claims

NuQuest Conditional Payment Investigation Service Includes:

  • Confirming claimant’s Social Security and Medicare status
  • Reporting the claim to Medicare to procure Conditional Payment information
  • Obtaining an estimate of Medicare Conditional Payments from Medicare (or MAP/Part D if requested)
  • Obtaining a prior decision or correspondence from Medicare

For more information on NuQuest’s Conditional Payer Payment Products, call (866) 858-7161.

Conditional Payment Negotiation Service Includes:

Two tiers for review of negotiation, not all negotiations go through legal review
        • First tier: $125/hour capped at three hours
              • Negotiation staff reviews the payment summary form from Medicare and determine whether each date of service is disputable.
              • If there is a state law defense, it is imperative the customer provide us with this information and any supporting documents.
        • Second tier – legal review $150/hour: capped at three hours
             • The customer can request legal review on any matter.
             • Legal will become involved if:
                          o appeal is after a usual regulatory deadline
                          o An argument available in the claim requires legal team to craft
                          o Customer requests legal review
         If QIC, ALJ or MAC appeal – this appeal is prepared by legal team and has no cap on fees
                          o NuQuest’s legal staff reviews all file documentation and prepares appeal letter
                          o Unless previously discussed with the customer, after review and preparing the appeal, the legal team will contact the customer if there is additional documentation that                             may support the appeal.
                          o Includes appearance by NuQuest’s legal staff for oral arguments and hearings if necessary

• These fees are billed at the time the negotiation letter is completed and submitted to the appropriate lien recovery entity. A copy of the appeal letter is provided to the referral source with the invoice.

• Follow up with the Medicare Recovery Contractor until a response and updated CP amount is received

For more information on NuQuest’s Conditional Payment Products, call (866) 858-7161