Medicare Secondary Payer Manual (Pub. 100-05), Ch. 7 § 70.10
Responding to Correspondence as a Result of the Issuance of the ITR Letter
70.10 – Responding to Correspondence as a Result of the Issuance of the ITR Letter
(Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24)
MSP Contractors that receive a response to an ITR letter that challenges the amount of the debt, shall reply
by standard U.S. mail using the appropriate letters. All replies to one of the jointly and severally liable
debtors shall also be copied and sent to the non-responding joint and severally liable debtor.
The MSP Contractor shall inform the debtor or debtors of the amount that remains subject to referral where
a debtor establishes that the debt or part of the debt should not be referred to Treasury due to one of the
exclusions. (The response should indicate what amount will be excluded from referral at this time and what
amount continues to be subject to referral).
MSP Contractors shall reply to ITR responses (i.e., posed defenses) within 30 calendar days of receipt and
update all appropriate systems (including HIGLAS) accordingly and timely.
In the event the response from the debtor or debtors is an actual repayment (either in part or in full), the
MSP Contractor shall apply the check to the debt within 20 calendar days of its receipt and update all
applicable internal and shared system financial/debt tracking systems.
MSP Contractors shall answer all inquiries resulting from the ITR letter. MSP Contractors shall bring
closure to all checks or posed defenses to a debt prior to any actual referral of the debt to Treasury for cross-
servicing via the HIGLAS system.
NOTE: For debtors that have administrative appeal rights and/or the right to request a waiver of recovery
under Section 1870 of the Act, the MSP Contractor shall evaluate whether any written reply constitutes an
implied appeal (if the time period for an appeal has not expired) or a request for a waiver has not previously
been requested.