Non-Submission Workers’ Compensation Medicare Set-Asides

This program offers full professional custodial services for WCMSA claims not submitted or approved by Medicare. Utilizing our Medical and Pharmacy Benefit Management resources, we make medical and pharmacy payments below the WC Fee Schedules.

What's Required

  1. The MSA funds
  2. The Court-Approved Settlement Documents
  3. The MSA (Allocation/Medical Cost Projection) report

Services Include:

  • WCMSA Custodial Agreements signed by all parties.
  • Annual financial statements provided to accounts showing interest earned, deposits and expenditures
  • Annual 1099-Interest forms provided to accounts for tax purposes/filing
  • Professional case management assistance
  • Utilization Review claim decisions as both injury-related and Medicare-covered
  • WC Fee Schedule adjustments
  • Medical and Pharmacy wallet-size insurance cards to assist with billing
  • Claims Payment Services
  • Bill Reviews (EOR/EOB) sent to providers along with payment
  • Pharmacy Benefit Management for cost containment and account sustainability

Structured Settlement Pricing

Set-Up Fee (one-time only): $1000

Annual Administration Fee:
$0 (If Seed Deposit is greater than $50,000)
$500 (If Seed Deposit is less than $50,000)

Lump Sum Pricing

Professional Administration Fee (one time only): $1,000