Medicare Secondary Payer Manual (Pub. 100-05), Ch. 7 § 60.8
Data Requirements and Format for Recommendations for Write-off/Closed
60.8 – Data Requirements and Format for Recommendations for Write-off/Closed
(Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24)
The request for Write-off/Closed requires the submission of a Debt Close-Out Report (a completed
checklist) that entails detailed information regarding the debts that are being closed out. Some of the fields
on the checklist to be completed by MSP Contractor are as follows:
a)
MSP Contractor name and number;
b)
Type of MSP Debt - GHP or NGHP (including liability, no-fault, and workers’ compensation);
c)
Beneficiary name;
d)
Name of debtor;
e)
Existing AR amount;
f)
Basis for recommendation.
g)
TIN for debtor, if available. There must always be a TIN for a provider, physician, other supplier, or
beneficiary debt. (The TIN is the Employer Identification Number (EIN) or Social Security Number (SSN).
NOTE: The debtor is the individual or entity to whom/which the last recovery demand was issued. Where
the demand was issued to an individual in his/her capacity as legal counsel or representative of any type, the
debtor is the beneficiary, provider, physician, other supplier, or other individual or entity being represented.
Where recovery is being pursued from the attorney or other representative in his/her own right, the debtor is
the attorney or other representative.
Where the TIN is unavailable, the MSP Contractor’s Write-off/Closed recommendation shall leave this field
blank.
The MSP Contractor’s Chief Financial Officer (CFO) must sign debt close-out reports. The CFO’s signature
constitutes his/her certification to all information/statements contained in the recommendation.
The MSP Contractor shall send the recommendations for the approval of Write-off/Closed no later than the
first day of the second month of each quarter (November 1, February 1, May 1, and August 1). The
recommendation may be sent electronically via secured email but it shall still include the validation
statement signed by the MSP Contractor’s CFO.