Medicare Secondary Payer (MSP) conditional-payment demand letter: what it means and what to do

A demand from the Benefits Coordination & Recovery Center (BCRC) for repayment of a conditional Medicare payment, usually after an accident, injury, or workers' compensation settlement. Starts its own Subpart I appeal — dispute which claims are related, or whether the amount is calculated right.

A Medicare Secondary Payer demand comes from the Benefits Coordination & Recovery Center (BCRC), not your MAC — a different process from an ordinary claim denial, but a real, appealable one.

120 days from the date of the demand letter — 120 calendar days from when you receive it (42 CFR § 405.942(a), applied to MSP recovery), with the same 5-day receipt presumption.rule42 CFR 405.942

These demands typically follow a liability settlement, a workers' compensation award, or a no-fault insurance payment related to an accident or injury — Medicare is asking to be repaid for care it conditionally covered before that settlement or award came through.

Interest on the debt accrues from the date of this letter, assessed every 30 days, whether or not a dispute is pending — paying now stops further interest, and if the dispute later succeeds, the payment is refunded.

If a settlement attorney handled the underlying accident or injury case, it's worth asking them directly whether MSP recovery is already part of their own scope before responding independently.

Read what Medicare says it paid. A Medicare Secondary Payer demand letter says Medicare made conditional payments for care related to an accident or injury, and wants that amount back — usually after a settlement.

Check which claims actually belong. The Payment Summary Form lists every claim included — check it against your own case; a claim for an unrelated condition doesn't belong on the demand.

Check the math. Medicare is required to reduce its own recovery for your attorney's fees and other real costs of getting the settlement — a demand that skips this is calculated wrong.

File within your deadline. 120 days from the date of the demand letter — 120 calendar days from when you receive it (42 CFR § 405.942(a), applied to MSP recovery), with the same 5-day receipt presumption.

An appeal disputes the demand itself — which claims belong on it, or whether the amount is right. A waiver of recovery, under Section 1870(c), asks Medicare to forgive the debt anyway for hardship, without disputing that it's owed. A compromise request asks Medicare to accept less than the full amount for a different reason — that full collection isn't realistic. Only the first two carry a formal appeal right if Medicare says no.ruleMedicare Secondary Payer (MSP) Manual, Chapter 7 — MSP Recovery