Just before the new year, CMS unleashed a brand new workflow for the conditional lien recovery process that rolled out a “120 day out from settlement notice to CMS” rule. It also released set guidelines for CMS lien communication. Both support more accurate and timely settlement outcomes.
As explained in my earlier 12/23/2025 post:
Authorized MSPRP users now have an option to notify CMS that a recovery case* is 120 days or less from a settlement. That notice then triggers a new enhanced CMS communication workflow. This “120 day out” notice 1. ensures that CMS addresses any lien relatedness disputes within 11 days of the dispute documentation, 2. allows parties to request a final CP amount, and 3. gives parties a time and date stamped final CP summary document before reaching settlement. This workflow yields timely lien verifications which in turn allow parties to calculate accurate net settlement amounts.
Below are some helpful general rules to help you stay clear on which CMS entity you need to communicate with re conditional payment liens.
CMS may elect to pursue recovery either from: 1. the primary payer ( i.e. plan/carrier ) , 2. the beneficary, or any other entity receiving a payment from the primary payer when there is a settlement, judgment, award , or other payment.
CMS generally elects to pursue the APPLICABLE PLAN when the plan has reported Ongoing Responsibility for Medicals (ORM) for the Beneficiary, or notifies CMS of otherwise direct responsibility for primary payment, such as with Workers Compensation and No- Fault insurance scenarios.
Here the communication flows through the CRC.
CMS generally pursues recovery directly from the BENEFICIARY as the debtor when a plan has NOT reported Ongoing Responsibility for Medicals (ORM) and has not otherwise notified CMS that it has primary payment responsibility.
Here the communication flows through the BCRC.
Note: These scenarios typically present when the beneficiary has received a lump sum settlement, judgment, award,or other payment. This usually is seen with liability and no fault insurance.
Also remember that if the BCRC was previously working on the case before the new changes, you should continue to work with them .
Remember most recovery cases are identified through that Section 111 reporting process. Correct reporting,along the rollout of enhanced ICD -10 medical coding, should improve the lien recovery process overall. More accurate injury and medical treatment descriptions with improved coding should help reduce errors in lien totals and speed up the negotiation process.