GHP Demand Letters

20.3 – GHP Demand Letters (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) The MSP Contractor shall provide the identified debtor (usually the employer/ other plan sponsor, or the employer is a federal employer, the insurer/ TPA) with sufficient materials to document a debt owed Medicare. An MSP recovery package should be sent for each demand made to an employer/other plan sponsor. The MSP recovery package has three main components: a) Demand letter addressed to the identified debtor; b) Summary of claims included in calculating the demand; and c) Claim facsimiles or claim detail for each claim mistakenly paid primary. The facsimiles or claim detail must contain the name of the provider, physician, or other supplier, the type or description of services, date of services, place, of service, charged amount and Medicare paid amount. The claims facsimiles are available to the employer/other plan sponsor upon request, but are only routinely sent to the insurer/claims processing TPA as a part of its courtesy copy. The recovery package must summarize and total the amount due Medicare. The total must equal the claim facsimiles or claim/detail. The MSP Contractor shall issue demand letters for all debts it believes are valid following the MSP Contractor’s required pre-demand validation, as specified in the MSP Contractor’s SOW. These demand letters shall include specific information regarding: the amount of the debt and how it arose; Medicare’s priority right of recovery; how to dispute the debt if the debtor feels it is not valid; and interest provisions. Information regarding the potential for referral to Treasury if the debt remains unresolved shall also be included. The MSP Contractor shall establish Accounts Receivable (AR) at the time the demand letter is issued. The AR date shall match the date printed on the demand letter. The MSP Contractor shall use HIGLAS to track all ARs with claims-level detail.