Lien Resolution Services

CONDITIONAL PAYMENT RESOLUTION

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.

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

Benefits

  • Minimize payments to Medicare
  • Utilize defenses and disputes for reimbursement
  • Reduce exposure to double damages
  • Exploit Medicare’s administrative appeal process and regulations

Conditional Payment Negotiation Service Includes:

 Two tiers for review of negotiation, not all negotiations go through legal review

  • First tier: capped at three hours
    • Negotiation staff reviews the payment summary form from Medicare and determines 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 – complex review: capped at three hours
    • The customer can request complex review on any matter
    • Legal will become involved if:
      • Appeal is after a usual regulatory deadline
      • An argument available in the claim requires complex review
      • Customer requests complex review
      • If QIC, ALJ or MAC appeal – this appeal is prepared by legal team and has no cap on fees
    • NuQuest’s legal staff reviews all file documentation and prepares appeal letter
    • 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
    • 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