Conditional Payment

Areas Serviced

  • Workers' Compensation

  • Liability Claims

Required Materials

  • Proper release signed by claimant/plaintiff

  • Printout of Medicare conditional payments

  • Associated medical records


Section 111 of the MMSEA reporting was mandated for one reason:  to alert CMS when the responsible reporting entity (RRE) has claims involving individuals entitled to Medicare.  Medicare then determines if it has made any 'conditional payments' on these cases.  If it has made any payment consistent with the ICD-9 codes of the primary payer's claim, Medicare will then pursue its right of recovery against the primary payer.