CMS has awarded the contract to review Workers’ Compensation Medicare Set-Aside submissions to a new vendor (Provider Resources, Inc.). The new contract runs through June 30, 2012. CMS mandated that the new contractor achieve significant decreases in the time it takes to complete the WCMSA submission process. CMS’ Request for Proposal (RFP) included provisions that require the review/approval of WCMSA proposals within 20 days.
If the submitted WCMSA lacks the requisite information for review/approval, the vendor has 5 days to issue a notification requesting additional information. Once the information has been provided, the contractor has 15 days to review the documents and review/approve the WCMSA.
CMS has further demanded that all telephone inquiries be answered within 24 hours of the inquiry and that written inquiries be responded to within 10 business days of the inquiry.
Although we are pleased with CMS’ efforts to increase the efficiency of the WCMSA submission process, we remain cautiously optimistic about the timelines. Approximately 2,000 WCMSA proposals are submitted to CMS each month and the 20 day approval period will likely be difficult to achieve. Although the contract commenced on July 1, 2011, we expect the transition to take time. We will continue to monitor the time associated with CMS review/approval of WCMSA proposals and keep you updated on industry trends.